Basic Applications of Lung Ultrasound in the Critically Ill: 2 – The Ultrasound Approach of an Acute Respiratory Failure: The BLUE Protocol

Abstract

The acute incapacity to breathe normally is one of the most distressing situations one can live with [1]. The BLUE protocol unites 18 years of efforts (mainly repeated submissions) aimed at relieving these suffocating patients. The idea of performing an ultrasound examination on such patients was not routine in 1989. Our approach possibly intrigued some doctors and nurses in the emergency rooms of our institutions. During management of these critical situations, there was not time for quiet explanations, and the tired emergency doctors, after duty, rushed for a deserved nap, therefore turning their backs on this potential. What these colleagues did not fully see was that, after a few minutes, we were able to give the nurses therapeutic options while organizing the transfer to the ICU. And what they did not see at all (occupied by a thousand other tasks) was that these options were in accordance with the final diagnosis. The publication of the BLUE protocol was one of the three main reasons, along with Chaps. 21 and 23, that justified this 2010 edition. The tools that are usually used in the emergency setting, i.e., the physical examination [2] and radiography [3], are not very precise. The crowded emergency room is not the ideal place for a serene and efficient diagnosis – an acknowledged issue [4–8]. One-quarter of the patients of the BLUE protocol in the first 2 h of management receive erroneous or uncertain initial diagnoses, and many more receive inappropriate therapy. The on-line document of Chest 134:117–125 details these 26% of wrong diagnoses. CT seems to be a solution, but Chap. 19 has already demonstrated its heavy drawbacks. One day, the community may find this tool to be too irradiating [9].