title: International evidence-based recommendations for point-of-care lung ultrasound.
abstract: BACKGROUND
  The purpose of this study is to provide evidence-based and expert consensus recommendations for lung ultrasound with focus on emergency and critical care settings.
  
  
  METHODS
  A multidisciplinary panel of 28 experts from eight countries was involved. Literature was reviewed from January 1966 to June 2011. Consensus members searched multiple databases including Pubmed, Medline, OVID, Embase, and others. The process used to develop these evidence-based recommendations involved two phases: determining the level of quality of evidence and developing the recommendation. The quality of evidence is assessed by the grading of recommendation, assessment, development, and evaluation (GRADE) method. However, the GRADE system does not enforce a specific method on how the panel should reach decisions during the consensus process. Our methodology committee decided to utilize the RAND appropriateness method for panel judgment and decisions/consensus.
  
  
  RESULTS
  Seventy-three proposed statements were examined and discussed in three conferences held in Bologna, Pisa, and Rome. Each conference included two rounds of face-to-face modified Delphi technique. Anonymous panel voting followed each round. The panel did not reach an agreement and therefore did not adopt any recommendations for six statements. Weak/conditional recommendations were made for 2 statements, and strong recommendations were made for the remaining 65 statements. The statements were then recategorized and grouped to their current format. Internal and external peer-review processes took place before submission of the recommendations. Updates will occur at least every 4 years or whenever significant major changes in evidence appear.
  
  
  CONCLUSIONS
  This document reflects the overall results of the first consensus conference on "point-of-care" lung ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. Recommendations were produced to guide implementation, development, and standardization of lung ultrasound in all relevant settings.
authors.affiliation: Department of Emergency Medicine, San Luigi Gonzaga University Hospital, 10043 Orbassano, Torino, Italy. gio.volpicelli@tin.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Volpicelli
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Elbarbary
authors.forename: Michael
authors.initials: M
authors.lastname: Blaivas
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Lichtenstein
authors.forename: Gebhard
authors.initials: G
authors.lastname: Mathis
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.forename: Lawrence
authors.initials: L
authors.lastname: Melniker
authors.forename: Luna
authors.initials: L
authors.lastname: Gargani
authors.forename: Vicki E
authors.initials: VE
authors.lastname: Noble
authors.forename: Gabriele
authors.initials: G
authors.lastname: Via
authors.forename: Anthony
authors.initials: A
authors.lastname: Dean
authors.forename: James W
authors.initials: JW
authors.lastname: Tsung
authors.forename: Gino
authors.initials: G
authors.lastname: Soldati
authors.forename: Roberto
authors.initials: R
authors.lastname: Copetti
authors.forename: Belaid
authors.initials: B
authors.lastname: Bouhemad
authors.forename: Angelika
authors.initials: A
authors.lastname: Reissig
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Rouby
authors.forename: Charlotte
authors.initials: C
authors.lastname: Arbelot
authors.forename: Andrew
authors.initials: A
authors.lastname: Liteplo
authors.forename: Ashot
authors.initials: A
authors.lastname: Sargsyan
authors.forename: Fernando
authors.initials: F
authors.lastname: Silva
authors.forename: Richard
authors.initials: R
authors.lastname: Hoppmann
authors.forename: Raoul
authors.initials: R
authors.lastname: Breitkreutz
authors.forename: Armin
authors.initials: A
authors.lastname: Seibel
authors.forename: Luca
authors.initials: L
authors.lastname: Neri
authors.forename: Enrico
authors.initials: E
authors.lastname: Storti
authors.forename: Tomislav
authors.initials: T
authors.lastname: Petrovic
mesh_terms: D003422:Critical Care; D004638:Emergency Treatment / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D038622:Internationality; D008171:Lung Diseases / Q000000981:diagnostic imaging*; D019095:Point-of-Care Systems; D014463:Ultrasonography