Échographie critique, une discipline holistique : exemple du FALLS-protocol (évaluation hémodynamique par l'échographie pulmonaire)

Lung ultrasound can be integrated in the ultrasound diagnosis of acute circulatory failure, using a sequential approach. The first step rules out obstructive shock such as pulmonary embolism, tamponade or tension pneumothorax. The second step consists in ruling out signs of interstitial edema, which would indicate cardiogenic shock. The third step is based on monitoring of lung parenchyma during fluid infusion to differentiate hypovolemic from septic shock, based on interstitial changes without clinical improvement. Ultrasound-based diagnosis of the mechanism of shock has to be compared with other haemodynamic data.