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6th Edition of World Congress on Infectious Diseases

June 24-26, 2024 | Paris, France

June 24 -26, 2024 | Paris, France
Infection 2024

Daniel A. Lichtenstein

Speaker at Infectious Diseases Conference - Daniel A. Lichtenstein
Ambroise Pare Hospital, France
Title : Ultrasound for diagnosing pneumonia. The place of the BLUE-protocol


The BLUE-protocol is an ultrasound approach of lungs and veins, allowing with fine accuracies an immediate diagnosis of an acute respiratory failure among the six causes which regard 97% of patients seen in critical settings: hemodynamic pulmonary edema, pulmonary embolism, pneumonia, COPD, asthma and pneumothorax, mainly. The BLUE-protocol is a fast protocol (less than 3 minutes). It requires a simple unit, uses the ten basic signs of lung ultrasound, and associates signs with locations. Three standardized points per lung are used. BLUE-protocol includes a venous analysis, different from usual habits (we don’t detail), done in the case of normal anterior lung surface The BLUE-protocol generates eight profiles, half devoted to diagnose pneumonia. The A-profile is a “pre-profile”, designing anterior lung sliding with anterior A-lines. It shows normal lung surface, and rules out immediately pneumothorax and hemodynamic pulmonary edema. It generates three profiles. The A-DVT profile means that a DVT was detected, and is 99% specific to pulmonary embolism. The A-V-PLAPS-profile. The PLAPS (posterior or lateral alveolar and/or pleural syndrome) indicates the presence of alveolar and/or pleural change, uni- or bilateral, at a subposterior point accessible in supine patients with short probes, called PLAPS-point. Alone, a PLAPS has no specificiy. Associated to the A-profile, when the venous network is free, it indicates (posterior) pneumonia with 89% accuracy. The nude profile, defined by the A-profile, absence of visible DVT and absence of PLAPS. It is usually associated to asthma or COPD (two diseases gathered because therapy is roughly similar). The B-profile, designing anterior lung sliding with anterior lung rockets indicates usually hemodynamic pulmonary edema. It rules out asthma, COPD, pulmonary embolism. The B-prime profile is a B-profile with abolished lung sliding. It is quite specific to pneumonia (100%). The A-prime profile is an A-profile with abolished lung sliding. It is highly suggestive of pneumothorax. The detection of a lung point will confirm the diagnosis and indicate the size of the pneumothorax. The A/B profile is an half A-profile at one lung, and an half B-profile at the other. It is quite specific to pneumonia. The C-profile indicates anterior lung consolidation, regardless size and number. A minima, it can just give the illusion of an irregular pleural line. It is quite specific to pneumonia (98%). 0One of the most frequent questions regards the non inclusion of the heart in the decision tree. This analysis is associated, not included, to the BLUE-protocol, which makes a direct analysis of the lung (the suffering organ). A simple cardiac sonography, without Doppler, will provide, at this step, major information, if needed. All these data are gathered in a traditional clinical approach, the aim is to provide quick relief of acute dyspnea, and decrease of use of irradiating tests. The BLUE-protocol is at best taught in authorized centres. It uses simple machines, one whole body probe for lungs, veins, heart, others. The BLUE-protocol is a typical illustration of holistic ultrasound.


Daniel Lichtenstein, medical intensivist, Ambroise-Paré Hospital (Paris), created holistic critical ultrasound in 1985 (Intensive Care Med 1993;19:353-355), defined by simple equipments, one universal probe for whole body, emphasis on lung, holistic cardiac sonography, veins, procedures (venous canulation...) extrapolable to multiple disciplines (pediatrics, pulmonology...), settings (ICU, austere areas...). Six hundred conferences. Six textbooks since 1992 (latest “Lung ultrasound in the criticall ill - the BLUE-protocol” - Springer 2016). Original articles including: BLUE-protocol (acute respiratory failure), FALLS-protocol (lung ultrasound in circulatory failure), SESAME-protocol (cardiac arrest), lung ultrasound in neonates. President of CEURF (training center at bedside in I.C.U.).