BLUE protocol
The BLUE (Bedside Lung Ultrasound in Emergency) protocol is a standardized method for using lung ultrasound in emergency and critical care settings.[1] In 2008, it was introduced by Daniel Lichtenstein and Gilbert Mezière and has been used to diagnose acute respiratory failure in critically ill patients.[1] It was first proposed in 1996 and rejected repeatedly until being accepted twelve years later.[2] Lung ultrasound has been shown to provide timely diagnosis of acute respiratory failure in about 90% of cases.[1] It can be performed under 3 minutes.[3]
Overview
[edit]The BLUE protocol is a systematic approach to evaluating lung pathology through ultrasound, allowing for rapid differentiation of conditions such as COPD or asthma, pneumothorax, pulmonary edema, pneumonia, and pulmonary embolism.[1] By assessing specific lung zones and identifying characteristic ultrasound patterns, clinicians can quickly determine the cause of respiratory failure at the bedside.[1] In the emergency department setting, the BLUE protocol can be modified for assessment of pericardial and pleural effusions.[4]
Methodology
[edit]The protocol involves scanning specific areas of the thorax using a bedside ultrasound machine.[1] There are three standardized points to scan: upper BLUE-point, lower BLUE-point and PLAPS (posterolateral alveolar and/or pleural syndrome)-point.[3][5] The interpretation of lung ultrasound findings follows established patterns, including A-lines, B-lines, lung sliding, and pleural effusions.[1] Based on the appearance of the images, it is identified as one of the following profiles: A (A lines in all 4 BLUE points), A' (A profile without lung sliding), B (3 or more B-lines in all 4 BLUE points), B' (B profile without lung sliding), and A/B (various findings of A lines and B lines) or C (consolidation in one of the BLUE points).[1]
Advantages and limitations
[edit]The protocol offers several advantages over traditional imaging methods such as chest X-ray and CT scans.[1] It is rapid, radiation-free, and cost-effective.[1]
It can be limited due to operator dependence, variability in interpretation, and need for the right equipment.[1]
References
[edit]- ^ a b c d e f g h i j k Lichtenstein, Daniel A.; Mezière, Gilbert A. (2008). "Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol". Chest. 134 (1): 117–125. doi:10.1378/chest.07-2800. ISSN 0012-3692. PMC 3734893. PMID 18403664.
- ^ Murali, Aparna; Prakash, Anjali; Dixit, Rashmi; Juneja, Monica; Kumar, Naresh (2022-11-30). "Lung ultrasound for evaluation of dyspnea: a pictorial review". Acute and Critical Care. 37 (4): 502–515. doi:10.4266/acc.2022.00780. ISSN 2586-6052. PMC 9732207. Archived from the original on 2025-02-12.
- ^ a b Lichtenstein, Daniel A. (2014-01-09). "Lung ultrasound in the critically ill". Annals of Intensive Care. 4 (1): 1. doi:10.1186/2110-5820-4-1. ISSN 2110-5820. PMC 3895677. PMID 24401163.
- ^ Bekgoz, Burak; Kilicaslan, Isa; Bildik, Fikret; Keles, Ayfer; Demircan, Ahmet; Hakoglu, Onur; Coskun, Gulhan; Demir, Huseyin Avni (2019-11-01). "BLUE protocol ultrasonography in Emergency Department patients presenting with acute dyspnea". The American Journal of Emergency Medicine. 37 (11): 2020–2027. doi:10.1016/j.ajem.2019.02.028. ISSN 0735-6757.
- ^ Lichtenstein, Daniel A.; Mezière, Gilbert A. (2011-08-01). "The BLUE-points: three standardized points used in the BLUE-protocol for ultrasound assessment of the lung in acute respiratory failure". Critical Ultrasound Journal. 3 (2): 109–110. doi:10.1007/s13089-011-0066-3. ISSN 2036-7902.