Lung ultrasound in acute respiratory failure an introduction to the BLUE-protocol.
Critical ultrasound, apparently a recent field, is in fact the outcome of a slow process, initiated since 1946. The lung was traditionally not considered as part of ultrasound, yet we considered its inclusion as a priority in our definition of critical ultrasound. Acute respiratory failure is one of the most distressing situations for the patient. An ultrasound approach of this disorder - the BLUE-protocol allows rapid diagnosis. Its main features will be described. Each kind of respiratory failure provides a particular ultrasound profile. In this difficult setting, initial mistakes are frequent. The BLUE-protocol proposes a step-by-step approach for making accurate diagnosis. By combining three signs with binary answer (anterior lung sliding, anterior lung-rockets), with venous analysis when required, seven profiles are generated, yielding a 90.5% accuracy. This rate is highly enhanced when simple clinical and laboratory data are considered. The BLUE-protocol can be achieved in three minutes, because the use of an intelligent machine, a universal probe, and standardized points allow major time-saving. Lung ultrasound in the critically ill was long available. In a domain where everything must be fast and accurate, the BLUE-protocol can play a major role in the diagnosis of an acute respiratory failure, usually answering immediately to questions where only sophisticated techniques were hitherto used.
Resuscitation Service, Ambroise-Paré Hospital, Faculté Paris-Ouest, Boulogne, France. dlicht@free.fr
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D000208:Acute Disease; D000328:Adult; D002648:Child; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D011030:Pneumothorax / Q000150:complications / Q000175:diagnosis; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography