The BLUE-Protocol and the Diagnosis of Pneumonia

Август 6, 2022

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The BLUE-Protocol and the Diagnosis of Pneumonia

Содержание

2. The BLUE-protocol is an ultrasound approach of the lung, and of the venous network in appropriate
3. WHICH DEVICE, WHICH PROBE?
4. Note: Lung sliding has been described as a shimmering appearance of the pleura, or like tiny
5. DESCRIBE THE MAIN PATHOLOGICAL PROFILE (PROFILE B) This aspect of multiple B lines and accompanied by
6. Pleural effusion. Left and middle: minute pleural effusion at the PLAPS-point. Below the pleural line, a
7. BASIC IDENTIFICATION . The A-line indicates gas below the pleural line ULCs (or B-lines) associated with
8. Merlin's space defines the area located between the pleural line, the shadow of the ribs and
9. DESCRIBE PROFILE A (NORMAL PULMONARY SURFACE image obtained in the normal subject when the probe is
10. DESCRIBE PROFILE B' (MAIN PATHOLOGICAL PROFILE) This video shows an interstitial syndrome close to the B
11. DESCRIBE PROFILE A' (PNEUMOTHORAX) This video shows a totally abolished pleural slip (with the stratosphere sign
12. Lung point This video shows a characteristic appearance of frontal lung point, an all-or-nothing law where
13. DESCRIBE PROFILE C (PNEUMOPATHY The detection of alveolar disorders (regardless of number and size) on the
14. DESCRIBE A/B PROFILE (PNEUMOPATHY) An anterior asymmetry, with a profile A on one side and profile
15. DESCRIBE A/PLAPS PROFILE (PNEUMOPATHY) It is defined by the association of a profile A (thus anterior)
16. DESCRIBE THE NUDE PROFILE /NON PLAP/COPD/ASTHMA Everything is normal in the nude profile, the appearance of
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The BLUE-protocol is an ultrasound approach of the lung, and of

the venous network in appropriate cases, allowing the rapid etiological diagnosis of an acute respiratory failure. It combines signs with localizations, The approach to acute respiratory failure: the BLUE-protocol
Acute respiratory failure is a life-threatening condition whose cause is sometimes difficult to recognize immediately.
Initial mistakes have deleterious consequences. BLUE-protocol, performed on dyspneic patients who will be admitted to the ICU, is a fast protocol: 3 minutes are required using suitable machines and the standardized points of analysis. Otherwise it can take longer (this time depends on the simplicity and adequacy of their equipment, of the standardization of their training).
Based on pathophysiology, it provides a step-by-step diagnosis of the main causes of acute respiratory failure, i.e., six diseases seen in 97% of patients in the emergency room, offering an overall 90.5% accuracy

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WHICH DEVICE, WHICH PROBE?

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Note: Lung sliding has been described as a shimmering appearance of the

pleura, or like tiny ants marching on a string. The pleura will seem to slide back and forth as the patient breathes.

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DESCRIBE THE MAIN PATHOLOGICAL PROFILE (PROFILE B)
This aspect of multiple B

lines and accompanied by a pleural slip, when it is visible on the 4 BLUE-points (thus anterior) is called "Profile B". At this point, the main diagnosis is Hemodynamic Pulmonary Acute Edema.
The B-profile suggests acute hemodynamic pulmonary
edema with 97% sensitivity and 95% specificity

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Pleural effusion. Left and middle: minute pleural effusion at the PLAPS-point. Below

the pleural line, a line regular and roughly parallel to the pleural line can be seen: the lung line, indicating the visceral pleura (arrows). This line, together with the pleural line and the shadow of the ribs, display a kind of quad: the quad sign. Right: M-mode shows a movement of the lung line (white arrows) toward the pleural line (black arrows) on inspiration—the sinusoid sign, indicating also a free pleural effusion, and a viscosity enabling the use of small caliper needle if thoracentesis is envisaged. E, expiration. Quantitative data: this effusion found at the PLAPS-point has an expiratory thickness of roughly 13 mm, i.e., an expectedly small volume (study in progress). A 15-mm distance is our minimum required for safe diagnostic or therapeutic puncture, allowing to simplify the problem of modeling the real volume of an effusion

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BASIC IDENTIFICATION
. The A-line indicates gas below the pleural line
ULCs (or B-lines) associated

with a fringed and irregular pleural line indicative of pulmonary fibrosis pattern.

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Merlin's space defines the area located between the pleural line, the shadow of the ribs

and the bottom of the image. The A-line (lower white arrows) is the repetition of the pleural line at a standardised distance, the skin–pleural line distance.

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DESCRIBE PROFILE A (NORMAL PULMONARY SURFACE
image obtained in the normal subject

when the probe is placed longitudinally on the lower BLUE-point: three points are identified successively. 1. The pleural line, by the sign of the bat (hyperechogenic line slightly lower than the line of the ribs). 2. The pleural slip. 3. Artefacts visible in Merlin's space: exclusive A lines here.

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DESCRIBE PROFILE B' (MAIN PATHOLOGICAL PROFILE)
This video shows an interstitial syndrome

close to the B profile, with the difference that pleural slippage is here abolished. This profile is called Profile B'. The priority diagnosis is lung disease Lung Rockets: The Ultrasound Sign of Interstitial Syndrome

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DESCRIBE PROFILE A' (PNEUMOTHORAX)
This video shows a totally abolished pleural slip

(with the stratosphere sign on the right, in TM mode). No B-lines are visible. This profile called A' profile is the characteristic aspect of a pneumothorax, which, if time permits, will need to be confirmed by the detection of a lung point.

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Lung point This video shows a characteristic appearance of frontal lung point,

an all-or-nothing law where an A' profile is replaced transiently, fleetingly and synchronously with breathing, in here a B profile. In the patient, the lung point was located in the PLAPS-point region, reflecting a significant volume pneumothorax.

PLAPS = Postero Lateral Alveolar &/or Pleural Syndrome.)

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DESCRIBE PROFILE C (PNEUMOPATHY
The detection of alveolar disorders (regardless of number

and size) on the anterior wall defines the C profile (for Consolidation), and prioritizes the diagnosis of pulmonary infection that causes acute respiratory failure.

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DESCRIBE A/B PROFILE (PNEUMOPATHY)
An anterior asymmetry, with a profile A on

one side and profile B on the other, is a true sign of infectious damage. This is the A/B profile, rare but almost specific.

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DESCRIBE A/PLAPS PROFILE (PNEUMOPATHY)
It is defined by the association of a

profile A (thus anterior) and a PLAPS (so later). Later consolidation and/or posterior pleural effusion, if not associated with a B-profile (transudative reaction in hemodynamic pulmonary edema), an A' profile (possible hemothorax in pneumothorax), or venous thrombosis (pulmonary infarction or pleural reaction during pulmonary embolism), are correlated in the BLUE-protocol to the diagnosis of pneumopathy. PLAPS = Posterio Lateral Alveolar &/or Pleural Syndrome.)

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DESCRIBE THE NUDE PROFILE /NON PLAP/COPD/ASTHMA
Everything is normal in the nude

profile, the appearance of profile A (by definition earlier) broadcast. The slip may be small, but it is present. Later rockets, possible, are not considered, as long as there is no PLAPS. The nude profile implies that no venous thrombosis has been detected. This is the usual profile of COPD and acute asthma.

The BLUE-Protocol and the Diagnosis of Pneumonia

Содержание

The BLUE-protocol is an ultrasound approach of the lung, and of

WHICH DEVICE, WHICH PROBE?

Note: Lung sliding has been described as a shimmering appearance of the

DESCRIBE THE MAIN PATHOLOGICAL PROFILE (PROFILE B) This aspect of multiple B

Pleural effusion. Left and middle: minute pleural effusion at the PLAPS-point. Below

BASIC IDENTIFICATION. The A-line indicates gas below the pleural lineULCs (or B-lines) associated

Merlin's space defines the area located between the pleural line, the shadow of the ribs

DESCRIBE PROFILE A (NORMAL PULMONARY SURFACEimage obtained in the normal subject

DESCRIBE PROFILE B' (MAIN PATHOLOGICAL PROFILE) This video shows an interstitial syndrome

DESCRIBE PROFILE A' (PNEUMOTHORAX)This video shows a totally abolished pleural slip

Lung point This video shows a characteristic appearance of frontal lung point,

DESCRIBE PROFILE C (PNEUMOPATHYThe detection of alveolar disorders (regardless of number

DESCRIBE A/B PROFILE (PNEUMOPATHY)An anterior asymmetry, with a profile A on

DESCRIBE A/PLAPS PROFILE (PNEUMOPATHY) It is defined by the association of a

DESCRIBE THE NUDE PROFILE /NON PLAP/COPD/ASTHMAEverything is normal in the nude

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