BLUE-Protocol and FALLS-Protocol Two Applications of Lung Ultrasound in the Critically Ill
BLUE-Protocol and FALLS-Protocol Two Applications of Lung Ultrasound in the Critically Ill
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DOI：
10.1378/chest.14-1313
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发表时间：
2015-06-01
期刊：
影响因子：
9.6
通讯作者：
Lichtenstein, Daniel A.
中科院分区：
文献类型：
--
作者：
Lichtenstein, Daniel A.
本文介绍了两种适用于肺超声的方案：床边急诊肺超声(BLUE)--用于急性呼吸衰竭的即时诊断方案和肺超声限制的液体给药(FALOS)--用于处理急性循环衰竭的方案。这些应用需要掌握10种征象，表明肺表面正常(蝙蝠征、肺滑动、A线)、胸腔积液(四边形和正弦征)、肺实变(分形征和组织样征)、间质综合征(肺火箭征)和气胸(平流层征和肺点)。这些体征已经在成人中进行了评估，诊断准确率从90%到100%不等，允许将超声视为合理的床边黄金标准。在BLUE方案中，已经为主要疾病(肺炎、充血性心力衰竭、COPD、哮喘、肺栓塞、气胸)设计了准确的配置文件。90%。在Fall方案中，从A线到肺火箭的变化出现在肺动脉阻断压为18 mm Hg的阈值，提供了临床容量的直接生物标志物。FLOWS方案依次排除梗阻性休克、心源性休克和低血容量性休克，以加快对分布性(通常是败血症)休克的诊断。这些应用可以使用简单的灰度机和一个适用于全身的微凸体探头来完成。肺部超声是一种多方面的工具，也可用于减少辐射剂量(在肺部征象与成人相似的新生儿中)，从ARDS到创伤处理，从ICU到护理地点。如果在合适的中心进行，培训是使用这种视觉医学的最小限制。
This review article describes two protocols adapted from lung ultrasound: the bedside lung ultrasound in emergency (BLUE)-protocol for the immediate diagnosis of acute respiratory failure and the fluid administration limited by lung sonography (FALLS)-protocol for the management of acute circulatory failure. These applications require the mastery of 10 signs indicating normal lung surface (bat sign, lung sliding, A-lines), pleural effusions (quad and sinusoid sign), lung consolidations (fractal and tissue-like sign), interstitial syndrome (lung rockets), and pneumothorax (stratosphere sign and the lung point). These signs have been assessed in adults, with diagnostic accuracies ranging from 90% to 100%, allowing consideration of ultrasound as a reasonable bedside gold standard. In the BLUE-protocol, profiles have been designed for the main diseases (pneumonia, congestive heart failure, COPD, asthma, pulmonary embolism, pneumothorax), with an accuracy. 90%. In the FALLS-protocol, the change from A-lines to lung rockets appears at a threshold of 18 mm Hg of pulmonary artery occlusion pressure, providing a direct biomarker of clinical volemia. The FALLS-protocol sequentially rules out obstructive, then cardiogenic, then hypovolemic shock for expediting the diagnosis of distributive (usually septic) shock. These applications can be done using simple grayscale machines and one microconvex probe suitable for the whole body. Lung ultrasound is a multifaceted tool also useful for decreasing radiation doses (of interest in neonates where the lung signatures are similar to those in adults), from ARDS to trauma management, and from ICUs to points of care. If done in suitable centers, training is the least of the limitations for making use of this kind of visual medicine.