Acute respiratory failure: The BLUE protocol
May 11, 2023
The BLUE (Bed Lung Ultrasound in Emergency) protocol, with an accuracy of more than 90% for diagnosing the cause of acute respiratory failure, can be used to
- Troubleshoot the etiology of acute respiratory failure
- Allow differentiation between pneumothorax, pneumonia, pulmonary embolism, pulmonary edema, and COPD or asthma
Here’s how we apply it in practice.
- Scan the 2 BLUE points on the left and right thorax
- Evaluate the presence of lung sliding (the absence of lung sliding will be indicated with a ‘).
- Check for lung artifacts (A-lines, B-lines, C-lines).
- Determine the profile based on the findings in all 4 BLUE points.
- A-profile: A-lines in all 4 BLUE points.
- B-profile: 3 or more B-lines in all 4 BLUE points.
- C-profile: A consolidation (C-line) present in one of the BLUE points.
- A/B profile: Various findings of A-lines and 3 or more B-lines in the 4 BLUE points.
- An A-profile or A’-profile requires further scanning.
- In case of an A-profile, thrombosed veins need to be excluded using the DVT protocol. When negative, the PLAPS point should be assessed to rule out consolidation.
- In case of an A’-profile, the chest wall should be scanned to rule in a lung point.
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