Lung Ultrasound in the Critically Ill

Lung ultrasound is a bedside noninvasive method allowing immediate assessment of most disorders impairing the function of this vital organ. Although little used for decades, lung ultrasound provides standardized and reproducible information, using a simple small grayscale hybrid unit (such as the one we have used since 1992, but 1982 machines have also proved excellent for this task). All of our work has described and assessed signs using computed tomography (CT) as a reference, demonstrating a high correlation between both tests. Considering the normal pattern and the main diagnoses, i.e., inter- stitial syndrome, pneumothorax, alveolar consolidation and pleural effusion, the control of no more than 10 signs provides a multitude of combinations allowing critical applications: accurate diagnosis of acute respiratory failure (a cyanotic patient, sometimes said to be undergoing the ‘blue protocol'), assessing thoracic pain from pleural or lung cause, safe management of chest tube insertion or thoracentesis, assessment of acute respiratory distress syndrome or trauma patients without need for transportation to CT, management of critically ill neonates, implementation of this discipline from sophisticated intensive care units to austere areas of the world, or hyper-sophisticated but remote areas (i.e., spacecraft). The combination of lung ultrasound with other critical targets like the venous system (the blue protocol) makes ultrasound a tool for visual medicine. Lung ultrasound can, with the same very simple material, be combined with other areas (heart, abdomen, etc.), providing a transparent overview of the critically ill. A new discipline can originate from the integration of lung and whole body ultrasound into traditional critical care. The training, if done in authorized training centers, is a minor problem, since lung ultrasound is far more accessible than fields such as cardiology or obstetrics. Our material makes lung ultrasound easy to perform with short training. Lung ultrasound has a role in nearly one half of clinical disciplines in medicine (pediatrics, pulmonology, family medicine, etc.), resulting in cost savings, relief from irradiation, and major simplification of the daily problems encountered when managing extreme health emergencies.