Acute respiratory failure: The BLUE protocol - NYSORA

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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

  1. Troubleshoot the etiology of acute respiratory failure
  2. 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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