The Extended-BLUE-Protocol

  • Daniel A. Lichtenstein


Warren Zapol wrote us one day: “.... As for rejections, they continue, even with age and celebrity. Persistence and resubmitting is what counts. Illegitimus non caborundum est.” We now know with years how right he was (regarding age). Regarding celebrity (and not losing time waiting its hypothetical arrival), we anticipate difficulties and delays and prefer to have less publications and give instead our non-peer-reviewed experience through this textbook. We share here the main aspects of the Extended BLUE-protocol. This is a concept considering the multiple interactions between diseases for increasing the accuracy of the BLUE-protocol (which was a preliminary work), from the initial 90.5 % to a value as near as possible to 100 % (Fig. 35.1). The value of 90.5 % is not bad for a discipline which was not supposed to exist, but we have now to answer more scientifically to issues heard here and there (why didn’t they include the heart? etc.).


Pulmonary Embolism Pleural Effusion Lung Ultrasound Lung Consolidation Septic Cardiomyopathy 
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Supplementary material

Video 35.1

A fully standstill cupola (in a necrotizing pneumonia). This video illustrates Fig. 29.3, in the LUCIFLR project (showing ultrasound superior when compared to CT), and Fig. 17.6, which shows the real dimensions of a consolidation. Here, the diaphragmatic cupola, perfectly exposed, is fully motionless – in a ventilated patient. It can therefore not be any phrenic palsy, as argued by some for explaining the frequent abolition of lung sliding in pneumonia. Look for the abolished lung sliding, fully redundant with the standstill cupola – or conversely too. Necrotizing pneumonia in a ventilated 76-year old man (MOV 3763 kb)

Video 35.2

The dynamic air bronchogram. In this huge lung consolidation, which quite fully impairs lung sliding, several among the multiple air bronchograms have an inspiratory centrifuge excursion – a sign correlated with a nonretractile consolidation. Here, pneumonia due to pneumococcus in a 42-year-old man (1982 technology) (MOV 2997 kb)


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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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