Ten Questions on Using Lung Ultrasonography to Diagnose and Manage Pneumonia in the Hospital-at-Home Model: Part I-Techniques and Patterns

Abstract

The hospital-at-home (HaH) model delivers hospital-level acute care, including diagnostics, monitoring, and treatments, in a patient's home. It is particularly effective for managing conditions such as pneumonia. Point-of-care ultrasonography (PoCUS) is a key diagnostic tool in the HaH model, and it often serves as a substitute for imaging-based diagnosis in the HaH setting. Both standard and handheld ultrasound equipment are suitable for lung ultrasound (LUS) evaluation. Curvelinear and linear probes are typically used. Patient positioning depends on their clinical condition and specific diagnostic protocols. To enhance sensitivity, we recommend using at least 10-point protocols supported by studies for pneumonia. Five essential LUS patterns should be identified, including A-line, multiple B-lines (alveolar-interstitial syndrome), confluent B-lines, subpleural consolidation, and consolidation with air bronchogram. Pleural effusion is common, and its internal echogenicity can indicate severity and the need for invasive procedures. The current evidence on various etiologies and types of pneumonia is limited, but LUS demonstrates good sensitivity in detecting abnormal sonographic patterns in atypical pneumonia, tuberculosis, and ventilator-associated pneumonia. Further LUS studies in the HaH setting are required to validate and generalize the findings.

Keywords: air bronchogram; consolidation; diagnosis; hospital-at-home; pneumonia; point-of-care; treatment; ultrasonography.

Figure 1

The (A) 8-point protocol (Point 1–4 for left hemithorax), (B) 10-point protocol (Point 1–5 for left hemithorax, (C) 12-zone protocol (Point 1–6 for left hemithorax), and (D) 14-zone protocols (Point 1–7 for left hemithorax) for the sonographic diagnosis of pneumonia in landmark studies, and the (E) modified BLUE protocol (1, superior BLUE point; 2, inferior BLUE point; D, diaphragm point; M, M-point; P, posterolateral point).

Figure 2

(A) A-line; (B) Multiple non-confluent B-lines; (C) Confluent B-lines; (D) Subpleural consolidation; (E) Large consolidation with air bronchogram.

Figure 3

Internal echogenicity of pleural effusion. (A) Anechoic: entirely echo-free fluid, (B) Complex non-septated: heterogeneously hyperechoic spots within the effusion, also referred to as the “Plankton sign”, (C) Complex septated: presence of visible septa or fibrin strands, and (D) Loculated: effusion confined between the parietal and visceral pleura with sharply defined margins.