Practical aspects of use of emergency sonography for differential diagnosis of critical respiratory incidents (Blue-protocol “Bedside Lung Ultrasound in Emergency”)

This article contains rather motivating than teaching information. It is a synthesis of analysis of authoritative global scientific publications and personal experience. The modern approaches to diagnosis of critical respiratory incidents using ultrasound, superficial theoretical review of the core of the method and our own experiences regarding effective protocol of sonographic lung assessment are presented here. Several interesting clinical cases emphasize the advantages of routine use of diagnostic ultrasound in patients with critical uncompensated respiratory disaster as well as in sub-compensated and compensated patients. The main principles of bedside lung ultrasound in emergency that should encourage wider implementation and use of this method by doctors of different specialties are: “Lung ultrasound is very easy to perform using simple equipment”, and “BLUE-protocol is a simple protocol that allows quick (< 3 min) diagnosis of the cause of respiratory failure”. Lung sonographic assessment allows not only to determine quickly the cause of critical respiratory failure and counteract it starting the etiotropic treatment as soon as possible, but also visualize the dynamics of pathological changes in response to therapy, thus allowing us to evaluate its effectiveness properly. The use of ultrasound in diagnosing enables more adequate decision making regarding the need of interventional therapy. It also leads to setting the right diagnosis faster, improving the quality of medical care, shortening the length of stay of patients in ICU, decreasing the total cost of the treatment. Identification and analysis of the amount of sonographic signs “B-lines – lung rockets” provides an opportunity to measure the volume/amount of interstitial lung fluid properly and track this marker/indicator in dynamics in response to the treatment. The unified method of protocolized assessment should be used within one medical facility in order to boost effectiveness and make evaluation and dynamic evaluation of pathological changes more objective by the same one or different medical specialists. Diagnostic ultrasound has a very low cost and there is no radiation exposure to patients which allows performing as many examinations as needed, without limitations.