Critical care ultrasound for ARDS: an adjunctive tool, not an alternative technique—a narrative review

Acute respiratory distress syndrome (ARDS) presents significant challenges in critical care medicine due to its complex pathophysiology and diverse etiologies. Critical care ultrasound (CCUS), also known as point-of-care ultrasound in the critical care setting, encompasses a variety of ultrasound applications tailored specifically to manage critically ill patients. In recent years, comprehensive critical care ultrasound evaluations, including pulmonary, cardiac, and diaphragmatic ultrasound, have improved the understanding of ARDS pathophysiology by visualizing respiratory dynamics and supporting diagnostic investigations. These modalities provide valuable information for etiology identification, severity assessment, and prognostic evaluation in ARDS patients, while recognizing that therapeutic decisions require integration with clinical context and established diagnostic standards. This narrative review aims to synthesize the current evidence and expert consensus on the use of critical care ultrasound in the management of ARDS. We will explore its role in diagnosis, monitoring, and prognostication, while critically evaluating its strengths and limitations as an adjunct to conventional imaging methods. We also outline future directions for research and development in this field, emphasizing the need for standardized protocols and additional training to maximize the benefits of CCUS in the critical care management of ARDS.