Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients.
OBJECTIVE
Bedside lung ultrasound (LUS) is a noninvasive, readily available imaging modality that can complement clinical evaluation. The Bedside Lung Ultrasound in Emergency (BLUE) protocol has demonstrated a high diagnostic accuracy in patients with acute respiratory failure (ARF). Recently, bedside LUS has been added to the medical training program of our ICU. The aim of this study was to investigate the accuracy of LUS based on the BLUE protocol, when performed by physicians who are not ultrasound experts, to guide the diagnosis of ARF.


METHODS
Over a one-year period, all spontaneously breathing adult patients consecutively admitted to the ICU for ARF were prospectively included. After training, 4 non-ultrasound experts performed LUS within 20 minutes of patient admission. They were blinded to patient medical history. LUS diagnosis was compared with the final clinical diagnosis made by the ICU team before patients were discharged from the ICU (gold standard).


RESULTS
Thirty-seven patients were included in the analysis (mean age, 73.2 ± 14.7 years; APACHE II, 19.2 ± 7.3). LUS diagnosis had a good agreement with the final diagnosis in 84% of patients (overall kappa, 0.81). The most common etiologies for ARF were pneumonia (n = 17) and hemodynamic lung edema (n = 15). The sensitivity and specificity of LUS as measured against the final diagnosis were, respectively, 88% and 90% for pneumonia and 86% and 87% for hemodynamic lung edema.


CONCLUSIONS
LUS based on the BLUE protocol was reproducible by physicians who are not ultrasound experts and accurate for the diagnosis of pneumonia and hemodynamic lung edema.
Federal University of Rio Grande do Sul, Porto Alegre, Brazil. Graduate Program in Respiratory Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Felippe Leopoldo
FL
Dexheimer Neto
Ernesto Dornelles Hospital, Porto Alegre, Brazil. Intensive Care Unit, Ernesto Dornelles Hospital, Porto Alegre, Brazil.
Juliana Mara Stormovski de
JM
Andrade
Ernesto Dornelles Hospital, Porto Alegre, Brazil. Intensive Care Unit, Ernesto Dornelles Hospital, Porto Alegre, Brazil.
Ana Carolina Tabajara
AC
Raupp
Ernesto Dornelles Hospital, Porto Alegre, Brazil. Intensive Care Unit, Ernesto Dornelles Hospital, Porto Alegre, Brazil.
Raquel da Silva
Rda S
Townsend
Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil. Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
Fabiana Gabe
FG
Beltrami
Université Pierre et Marie Curie, Paris, France, Hospital Practitioner. Multidisciplinary Intensive Care Unit (Prof. J.J. Rouby), Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris - AP-HP, Public Assistance-Paris Hospitals - Université Pierre et Marie Curie - UPMC, Pierre and Marie Curie University - Paris 6, Paris, France.
Hélène
H
Brisson
Université Pierre et Marie Curie, Paris, France, Hospital Practitioner. Multidisciplinary Intensive Care Unit (Prof. J.J. Rouby), Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris - AP-HP, Public Assistance-Paris Hospitals - Université Pierre et Marie Curie - UPMC, Pierre and Marie Curie University - Paris 6, Paris, France.
Qin
Q
Lu
Federal University of Rio Grande do Sul, Department of Internal Medicine, Porto Alegre, Brazil, Associate Professor. Department of Internal Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Paulo de Tarso Roth
Pde T
Dalcin
D018806:APACHE; D000208:Acute Disease; D000368:Aged; D001938:Brazil; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011014:Pneumonia / Q000150:complications / Q000000981:diagnostic imaging; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000150:complications / Q000000981:diagnostic imaging; D012131:Respiratory Insufficiency / Q000145:classification / Q000000981:diagnostic imaging* / Q000209:etiology; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
Intensive care units; Respiratory insufficiency; Ultrasonography, interventional