Hsu Nin-Chieh, Lin Yu-Feng, Tsai Hung-Bin, Liao Charles, Hsu Chia-Hao
Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan.
Division of Hospital Medicine, Department of Internal Medicine, Taipei City Hospital Zhongxing Branch, Taipei 103212, Taiwan.
Diagnostics (Basel). 2025 May 9;15(10):1200. doi: 10.3390/diagnostics15101200.
The hospital-at-home (HaH) model offers hospital-level care within patients' homes and has proven effective for managing conditions such as pneumonia. The point-of-care ultrasonography (PoCUS) is a key diagnostic tool in this model, especially when traditional imaging modalities are unavailable. This review explores how PoCUS can be optimized to manage pneumonia in HaH settings, focusing on its diagnostic accuracy in patients with comorbidities, differentiation from mimickers, and role in assessing disease severity. Pulmonary comorbidities, such as heart failure and interstitial lung disease (ILD), can complicate lung ultrasound (LUS) interpretation. In heart failure, combining lung, cardiac, and venous assessments (e.g., IVC collapsibility, VExUS score) improves diagnostic clarity. In ILD, distinguishing chronic changes from acute infections requires attention to B-line patterns and pleural abnormalities. PoCUS must differentiate pneumonia from conditions such as atelectasis, lung contusion, cryptogenic organizing pneumonia, eosinophilic pneumonia, and neoplastic lesions-many of which present with similar sonographic features. Serial LUS scoring provides useful information on pneumonia severity and disease progression. Studies, particularly during the COVID-19 pandemic, show correlations between worsening LUS scores and poor outcomes, including increased ventilator dependency and mortality. Furthermore, LUS scores correlate with inflammatory markers and gas exchange metrics, supporting their prognostic value. In conclusion, PoCUS in HaH care requires clinicians to integrate multi-organ ultrasound findings, clinical context, and serial monitoring to enhance diagnostic accuracy and patient outcomes. Mastery of LUS interpretation in complex scenarios is crucial to delivering personalized, high-quality care in the home setting.
居家医院（HaH）模式可在患者家中提供医院级护理，并且已被证明在管理肺炎等病症方面有效。即时超声检查（PoCUS）是该模式中的关键诊断工具，尤其是在无法使用传统成像方式时。本综述探讨了如何优化PoCUS以管理居家医院环境中的肺炎，重点关注其在合并症患者中的诊断准确性、与模仿病症的鉴别以及在评估疾病严重程度中的作用。肺部合并症，如心力衰竭和间质性肺疾病（ILD），会使肺部超声（LUS）解读变得复杂。在心力衰竭中，结合肺部、心脏和静脉评估（例如下腔静脉塌陷度、VExUS评分）可提高诊断清晰度。在ILD中，区分慢性变化与急性感染需要关注B线模式和胸膜异常。PoCUS必须将肺炎与肺不张、肺挫伤、隐源性机化性肺炎、嗜酸性粒细胞性肺炎和肿瘤性病变等病症区分开来，其中许多病症具有相似的超声特征。连续LUS评分可提供有关肺炎严重程度和疾病进展的有用信息。研究表明，尤其是在COVID-19大流行期间，LUS评分恶化与不良结局之间存在关联，包括呼吸机依赖增加和死亡率上升。此外，LUS评分与炎症标志物和气体交换指标相关，支持其预后价值。总之，居家医院护理中的PoCUS要求临床医生整合多器官超声检查结果、临床背景和连续监测，以提高诊断准确性和患者结局。掌握复杂情况下的LUS解读对于在家庭环境中提供个性化、高质量护理至关重要。
