Bedside Lung Ultrasound in Emergency Protocol as a Diagnostic Tool in Patients of Acute Respiratory Distress Presenting to Emergency Department

J Emerg Trauma Shock. Apr-Jun 2018;11(2):125-129. doi: 10.4103/JETS.JETS_21_17.

Abstract

Objective: The objective of this study is to determine the accuracy of the bedside lung ultrasound in emergency (BLUE) protocol in giving a correct diagnosis in patients presenting with acute respiratory distress in emergency department.

Materials and methods: Patients with acute respiratory distress were evaluated. Ultrasound findings such as artifacts (A line, B line), lung sliding, alveolar consolidation or pleural effusion, and venous analysis were recorded. Ultrasonography findings were correlated with final diagnosis made by the treating unit. Sensitivity and specificity were calculated.

Results: A total 50 patients were evaluated. The A profile (predominant A line with lung sliding) indicated chronic obstructive pulmonary disease/asthma (n = 14) with 85.17% sensitivity and 88.88% specificity. B profile (predominant B + lines with lung sliding) indicated pulmonary edema (n = 13) with 92.30% sensitivity and 100% specificity. The A/B profile (A line on one side and B + line on other side) and the C profile (anterior consolidation) and the A profile plus posterolateral alveolar and/or pleural syndrome indicated pneumonia (n = 17) with 94.11 sensitivity and 93.93% specificity. The A profile plus venous thrombosis indicated pulmonary embolism (n = 1) with 100% sensitivity and specificity. A' profile (predominant A line without lung sliding) with lung point indicated pneumothorax (n = 5) with 80% sensitivity and 100% specificity.

Conclusion: BLUE protocol was successful in average 90.316% cases. BLUE performed in emergency department is equivalent to computed tomography scan. BLUE protocol aids in making diagnosis and saves time and cost; avoids the side effects related to radiation.

Keywords: Bedside lung ultrasound in emergency; emergency medicine; respiratory failure; ultrasound.