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Western
Sussex
Hospitals
NHS
Foundation
Trust
Critical Care Lung Ultrasound
Dr Tim Martindale
Deborah Dykes
Lung Ultrasound
• Why bother? What’s wrong with my
stethoscope?
• Ultrasound views / pathologies
• Live demonstration
• Training Pathway
Lung Ultrasound
• Daniel Lichtenstein
• 2008 – Seminal
paper ‘Relevance of
lung ultrasound in
the diagnosis of
acute respiratory
failure: the BLUE
protocol.
• Quick (<3 mins)
Overall diagnostic accuracy of
BLUE Protocol
Sensitivity (%) Specificity (%) PPV (%) NPV (%)
Cardiogenic pulmonary
oedema
97 95 87 99
COPD / Asthma 89 97 93 95
PE 81 99 94 98
Pneumothorax 88 100 100 99
Pneumonia 89 94 88 95
Overall Diagnostic Accuracy of BLUE Protocol 90.5
Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008;
134: 117–125
Lung Ultrasound
Auscultation vs CXR vs USS
Auscultation Chest radiography Lung ultrasonography
Pleural effusion
Sensitivity 42 39 92
Specificity 90 85 93
Diagnostic accuracy 61 47 93
Alveolar consolidation
Sensitivity 8 68 93
Specificity 100 95 100
Diagnostic accuracy 36 75 97
Alveolar-interstitial syndrome
Sensitivity 34 60 98
Specificity 90 100 88
Diagnostic accuracy 55 72 95
Daniel Lichtenstein, Ivan Goldstein, Eric Mourgeon, Philippe Cluzel, Philippe Grenier, Jean-
Jacques Rouby; Comparative Diagnostic Performances of Auscultation, Chest Radiography, and
Lung Ultrasonography in Acute Respiratory Distress Syndrome. Anesthesiology 2004;100(1):9-15.
Lung Ultrasound
• Lung Ultrasound best
performed using simple
equipment
• All signs (except subcutaneous
emphysema) arise from the
pleural line
The BLUE-points: three standardized points used in the BLUE-protocol for ultrasound
assessment of the lung in acute respiratory failure
Decision tree of the BLUE protocol.
Daniel Lichtenstein Breathe 2017;13:100-111
THIS MACHINE
HAS NO BRAIN.
USE YOUR OWN
A Lines (Normal)
• A- Lines
B Lines
Lung Ultrasound views
Effusion
Pneumonia
Air bronchograms
Effusion and Pneumonia
Pneumothorax
Pneumothorax
Pneumothorax
Lung Ultrasound
• Live scanning
Decision tree of the BLUE protocol.
Daniel Lichtenstein Breathe 2017;13:100-111
Case presentation
• 58yr old lady
• Severe
Bronchiectasis +-
Infection
• Increasing O2
requirements –
Lung USS
Case Presentation - LU
Case Presentation - LL
Case Presentation – L PLAPS
Case Presentation - RU
Case Presentation - RL
Case Presentation – R PLAPS
Physiotherapy and Lung
Ultrasound
• DD
Training pathway
• CUSIC
• https://www.ics.ac.uk/ICS/cusic.aspx
• Register and Pre-approved Course
• Thoracic – 10 Supervised, 20 mentored
• DVT – 5 Supervised, 5 mentored
• Abdominal 10 Supervised, 15 mentored
• Triggered Assessment
• Procedural for Doctors
Western
Sussex
Hospitals
NHS
Foundation
Trust
Thank you
