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Lung Ultrasound in ARDS: The Pink-Protocol. The Place of Some Other Applications in the Intensive Care Unit (CLOT-Protocol, Fever-Protocol)

  • Daniel A. Lichtenstein

Abstract

Some critically ill patients with massive loss of lung function are not dyspneic, not blue, and have a quiet breathing, just because they are deeply sedated and curarized on occasion and receive pure oxygen. This is mainly the case of ARDS. Lung ultrasound in these patients does not strictly obey to the rules of the BLUE-protocol. This setting was called the Pink-protocol. Not surprisingly in our discipline, the definitions of ARDS changed recently. A homogeneous management is en route, but not fully achieved, with space for discussion [1, 2]. It is peculiar to see that, even if lung ultrasound was of possible use when ARDS was defined [3], in the 2012 definition, lung ultrasound was still not fully, deeply integrated (Anecdotical Note 1). Time will correct this. We assume that LUCI will clarify more than confuse, helping in better classifying this multifaceted disease. The lung is a complex organ, and such an injury (ARDS) can complexify the field even more [4, 5]. Hopingly, an intensive use of ultrasound (lung, veins, diaphragm, heart, etc.) may optimize patient’s survival or quicker discharge from the ICU.

Keywords

Lung Ultrasound Maxillary Sinusitis Common Femoral Vein Quiet Breathing Pleural Line 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 28.1

Jugular internal floating thrombosis. In this jugular internal vein, this 1982 technology, associated with a low-quality digitalization, shows however a floating thrombosis with systolodiastolic halting movements: the mass is obviously attracted by the right auricular diastole. One guesses the severity of these findings. The small footprint probe of this ADR-4000 was inserted on the supraclavicular fossa, allowing to see the Pirogoff confluence. (MOV 5043 kb)

References

  1. 1.
    Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome : the Berlin definition. JAMA 307(23):2526–2533PubMedGoogle Scholar
  2. 2.
    Malbrain M (2014). I don’t like the Berlin definitions of ARDS (abstract). 11th Annual critical care symposium. Veerappan Chithambaram, ManchesterGoogle Scholar
  3. 3.
    Ashbaugh DG (1967) Acute respiratory distress in adults. Lancet 2(7511):319–323CrossRefPubMedGoogle Scholar
  4. 4.
    West BJ. Respiratory physiology. The essentials. 9th Ed. 2012. Philadelphia, Baltimore. Wolters Kluwer, Lippincott Williams & WilkinsGoogle Scholar
  5. 5.
    Guyton CA, Hall JE (1996) Textbook of medical physiology, 9th edn. W.B. Saunders Company, Philadelphia, pp 212–234Google Scholar
  6. 6.
    Lichtenstein D, Mezière G (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure. The BLUE-protocol. Chest 134:117–125CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Talmor M, Hydo L, Gershenwald JG, Barie PS (1998) Beneficial effects of chest tube drainage of pleural effusion in acute respiratory failure refractory to PEEP ventilation. Surgery 123:137–143CrossRefPubMedGoogle Scholar
  8. 8.
    Roch A, Bojan M, Michelet P, Romain F, Bregeon F, Papazian L, Auffray JP (2005) Usefulness of ultrasonography in predicting pleural effusion >500 mL in patients receiving mechanical ventilation. Chest 127:224–232CrossRefPubMedGoogle Scholar
  9. 9.
    Vignon P, Chastagner C, Berkane V, Chardac E, Francois B, Normand S, Bonnivard M, Clavel M, Pichon N, Preux PM, Maubon A, Gastinne H (2005) Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography. Crit Care Med 33:1757–1763CrossRefPubMedGoogle Scholar
  10. 10.
    Balik M, Plasil P, Waldauf P, Pazout J, Fric M, Otahal M, Pachl J (2006) Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med 32:318–321CrossRefPubMedGoogle Scholar
  11. 11.
    Remérand F, Dellamonica J, Mao Z, Ferrari F, Bouhemad B, Jianxin Y, Arbelot C, Lu Q, Ichaï C, Rouby JJ (2010) Multiplane ultrasound approach to quantify pleural effusion at the bedside. Intensive Care Med 36(4):656–664CrossRefPubMedGoogle Scholar
  12. 12.
    Lichtenstein D, Hulot JS, Rabiller A, Tostivint T, Mezière G (1999) Feasibility and safety of ultrasound-aided thoracentesis in mechanically ventilated patients. Intensive Care Med 25:955–958CrossRefPubMedGoogle Scholar
  13. 13.
    Depardieu F, Capellier G, Rontes O, Blasco G, Balvay P, Belle E, Barale F (1997) Conséquence du drainage des épanchements liquidiens pleuraux chez les patients de réanimation ventilés. Ann Fr Anesth Reanim 16:785CrossRefGoogle Scholar
  14. 14.
    Ahmed SH, Ouzounian SP, Dirusso S, Sullivan T, Savino J, Del Guercio L (2004) Hemodynamic and pulmonary changes after drainage of significant pleural effusions in critically ill, mechanically ventilated surgical patients. J Trauma 57:1184–1188CrossRefPubMedGoogle Scholar
  15. 15.
    Nishida O, Arenallo R, Cheng DCH, DeMajo W, Kavanagh BP (1999) Gas exchange and hemodynamics in experimental pleural effusion. Crit Care Med 27:583–587CrossRefPubMedGoogle Scholar
  16. 16.
    Keenan JC, Formenti P, Marini JJ (2014) Lung recruitment in ARDS : what is the best strategy? Curr Opin Crit Care 20(1):63–68CrossRefPubMedGoogle Scholar
  17. 17.
    Vieillard-Baron A, Charron C, Jardin F (2006) Lung “recruitment” or lung overinflation maneuvers ? Intensive Care Med 32:177–178CrossRefPubMedGoogle Scholar
  18. 18.
    Tocino IM, Miller MH, Fairfax WR (1985) Distribution of pneumothorax in the supine and semi-recumbent critically ill adult. AJR Am J Roentgenol 144:901–905CrossRefPubMedGoogle Scholar
  19. 19.
    Kurdziel JC, Dondelinger RF, Hemmer M (1987) Radiological management of blunt polytrauma with CT and angiography: an integrated approach. Ann Radiol 30:121–124PubMedGoogle Scholar
  20. 20.
    Hill SL, Edmisten T, Holtzman G, Wright A (1999) The occult pneumothorax: an increasing diagnostic entity in trauma. Am Surg 65:254–258PubMedGoogle Scholar
  21. 21.
    McGonigal MD, Schwab CW, Kauder DR, Miller WT, Grumbach K (1990) Supplemented emergent chest CT in the management of blunt torso trauma. J Trauma 30:1431–1435CrossRefPubMedGoogle Scholar
  22. 22.
    Gobien RP, Reines HD, Schabel SI (1982) Localized tension pneumothorax: unrecognized form of barotrauma in ARDS. Radiology 142:15–19CrossRefPubMedGoogle Scholar
  23. 23.
    Lichtenstein D, Mezière G, Lascols N, Biderman P, Courret JP, Gepner A, Goldstein I, Tenoudji-Cohen M (2005) Ultrasound diagnosis of occult pneumothorax. Crit Care Med 33:1231–1238CrossRefPubMedGoogle Scholar
  24. 24.
    Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Gentiloni Silveri N (2008) Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department. Chest 133:204–211CrossRefPubMedGoogle Scholar
  25. 25.
    Lichtenstein D, Mezière G, Biderman P, Gepner A, Barré O (1997) The comet-tail artifact, an ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 156:1640–1646CrossRefPubMedGoogle Scholar
  26. 26.
    Schmidt GA (1998) Pulmonary embolic disorders. In: Hall JB, Schmidt GA, Wood LDH (eds) Principles of critical care, 2nd edn. McGraw-Hill, New York, pp 427–449Google Scholar
  27. 27.
    Minet C, Lugosi M, Savoye PY, Menez C, Ruckly S, Bonadona A, Schwebel C, Hamidfar-Roy R, Dumanoir P, Ara-Somohano C, Ferretti GR, Timsit JF (2012) Pulmonary embolism in mechanically ventilated patients requiring computed tomography: prevalence, risk factors and outcome. Crit Care Med 40:3202–3208CrossRefPubMedGoogle Scholar
  28. 28.
    Chastre J, Cornud F, Bouchama A, Viau F, Benacerraf R, Gibert C (1982) Thrombosis as a complication of pulmonary-artery catheterization via the internal jugular vein. N Engl J Med 306:278–280CrossRefPubMedGoogle Scholar
  29. 29.
    Gooding GAW, Hightower DR, Moore EH, Dillon WP, Lipton MJ (1986) Obstruction of the superior vena cava or subclavian veins: sonographic diagnosis. Radiology 159:663–665CrossRefPubMedGoogle Scholar
  30. 30.
    Philbrick JT, Becker DM (1988) Calf deep venous thrombosis: a wolf in sheep’s clothing ? Arch Intern Med 148:2131–2138CrossRefPubMedGoogle Scholar
  31. 31.
    Lichtenstein D (2007) Point of care ultrasound: infection control on the ICU. Crit Care Med 35(Suppl):S262–S267CrossRefPubMedGoogle Scholar
  32. 32.
    Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903CrossRefPubMedGoogle Scholar
  33. 33.
    Lichtenstein D, Biderman P, Mezière G, Gepner A (1998) The sinusogram, a real-time ultrasound sign of maxillary sinusitis. Intensive Care Med 24:1057–1061CrossRefPubMedGoogle Scholar
  34. 34.
    Yagi K, Kawakami M, Sugimoto T (1988) A clinical study of thrombus formation associated with central venous catheterization. Nippon Geka Gakkai Zasshi 89:1943–1949PubMedGoogle Scholar
  35. 35.
    Horattas MC, Wright DJ, Fenton AH, Evans DM, Oddi MA, Kamienski RW, Shields EF (1988) Changing concepts of deep venous thrombosis of the upper extremity: report of a series and review of the literature. Surgery 104:561–567PubMedGoogle Scholar
  36. 36.
    Monreal M, Lafoz E, Ruiz J, Valls R, Alastrue A (1991) Upper-extremity deep venous thrombosis and pulmonary embolism: a prospective study. Chest 99:280–283CrossRefPubMedGoogle Scholar
  37. 37.
    Haeger K (1969) Problems of acute deep vein thrombosis: the interpretation of signs and symptoms. Angiology 20:219–223CrossRefPubMedGoogle Scholar
  38. 38.
    Rose SC, Zwiebel JZ, Miller FJ (1994) Distribution of acute lower extremity deep venous thrombosis in symptomatic and asymptomatic patients: imaging implications. J Ultrasound Med 13:243–250CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Daniel A. Lichtenstein
    • 1
  1. 1.Hôpital Ambroise Paré Service de Réanimation MédicaleBoulogne (Paris-West University)France

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