Abstract
Lung ultrasound, which allows a bedside visualization of the lungs, is increasingly used in critical care. This review aims at highlighting a simple approach to this new discipline. The 10 basic signs are the bat sign (indicating pleural line), lung sliding (yielding the seashore sign), the A line (horizontal artifact), the quad and sinusoid sign indicating pleural effusion regardless of its echogenicity, the tissue-like and shred sign indicating lung consolidation, the B line and lung rockets (artifacts indicating interstitial syndrome), abolished lung sliding with the stratosphere sign, suggesting pneumothorax, and the lung point, indicating pneumothorax. All these disorders were assessed using computed tomography (CT) as a gold standard with sensitivity and specificity ranging from 90 to 100%, allowing us to consider ultrasound as a reasonable bedside gold standard in the critically ill. We use a simple gray-scale unit (without Doppler) with a microconvex probe. Lung ultrasound can be used for diagnosing acute respiratory failure (BLUE protocol), managing acute circulatory failure (Fluid Administration Limited by Lung Sonography protocol), and decreasing the use of radiograph or CT (the Lung Ultrasound in the Critically Ill Favoring Limitation of Radiation project). This can be extended from sophisticated ICUs to more austere settings, from neonates to bariatric adults without adaptation, trauma and several other disciplines (anesthesiology, emergency medicine, pulmonology, etc.). http://links.lww.com/COCC/A8.
Highlights
Lung ultrasound is a basic application of critical ultrasound, defined as a loop associating urgent diagnoses with immediate therapeutic decisions
Lung ultrasound would be of minor interest if the usual tools did not have drawbacks
We used ultrasound first in 1983, on occasion in François Fraisse’s ICU in 1985–1989, since 1989 in François Jardin’s ICU, using the on-site 1982 ADR-4000 devoted to cardiac assessment, in actual fact suitable for whole body and lung assessment and not larger than nowadays laptops [1]
Summary
Dressings and subcutaneous emphysema make unsuperable limitations. Exceptional cases provide difficult interpretation, even for experts. Care should be taken to confide training to experts choosing simplicity, one can practice lung ultrasound with any machine, any probe, any teaching approach. Our work was mainly to provide standardized signs, a major advantage of lung ultrasound, because the risk of wrong interpretations is highly decreased. Conclusions Lung ultrasound allows fast, accurate, bedside examinations of most acute respiratory disorders. Ultrasound has quite similar performances to CT [12,17,20,30,37], being on occasion superior: better detection of pleural septations, necrotic areas [66], real-time measurement allowing assessment of dynamic signs: lung-sliding, air bronchogram [67], diaphragm [68,69]. Lung ultrasound will favor programs allowing decrease in bedside radiographs and CTs in the decades. Competing interest The author declares that he has no competing interests
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