0
Correspondence |

Utility of Lung Sonography in Acute Respiratory Failure FREE TO VIEW

Rahul Khosla, MD
Author and Funding Information

Veterans Affairs Medical Center Washington, DC

Correspondence to: Rahul Khosla, MD, Veterans Affairs Medical Center, Department of Pulmonary & Critical Care Medicine, 50 Irving St NW, Washington, DC 20422; e-mail: rkhosla8@yahoo.com


The author has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(3):884. doi:10.1378/chest.08-1922
Text Size: A A A
Published online

To the Editor:

I read with interest the article written by Drs. Lichtenstein and Mezière1 in a recent issue of CHEST (July 2008) on the use of ultrasound to make a rapid diagnosis in patients with acute respiratory failure with the BLUE protocol. In the “Materials and Methods” section of the article, it is says that the ultrasound examination took no longer than 3 min. If the test was limited to just the evaluation of the lungs, one can believe that in experienced hands 3 min would be sufficient. But going by the protocol, a patient with an A profile (ie, anterior predominant bilateral A lines with lung sliding) would require venous analysis. In my opinion, it is not possible to do venous analysis for deep vein thrombosis within 3 min, even if one is limiting the study to compression sonography.2

In a patient with underlying chronic interstitial syndrome, it would be very difficult to differentiate acute exacerbation of the underlying disease from pulmonary edema; hence, the knowledge of a patient's medical history is crucial in such a situation.3 Pneumonia can present with different profiles (A, anterior predominant bilateral A lines with lung sliding; A/B, anterior predominant B+ lines on one side and predominant A lines on the other side; C, anterior alveolar consolidations; and B′, anterior predominant B+ lines with abolished lung sliding), which can make it confusing for clinicians especially while they are learning the use of lung sonography.

I find lung sonography to be very useful in patients with conditions such as pulmonary edema and pleural effusions, and in ruling out pneumothorax.4,5 For other clinical presentations such as COPD, pneumonia, asthma, and pulmonary embolism, one may have to acquire extensive experience before becoming comfortable in interpreting the results. The authors excluded 41 patients from analysis (16 patients with an unknown diagnosis, 16 with several final diagnoses, and 9 with a rare diagnosis). In clinical practice, these are the very patients who cause a diagnostic dilemma, in whom, besides a clinical examination and basic laboratory tests, clinicians would want to perform a diagnostic test with high accuracy. The yield of ultrasonography would decline if these patients were considered for statistical analysis.

Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134:117-125. [PubMed] [CrossRef]
 
Kheir DE. One time comprehensive ultrasonography to diagnose deep vein thrombosis: is that the solution. Ann Intern Med. 2004;140:1052-1053. [PubMed]
 
Lichtenstein D, Mezière G, Biderman P, et al. The comet-tail artifact: an ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;156:1640-1646. [PubMed]
 
Beaulieu Y, Marik PE. Bedside ultrasonography in the ICU: part 1. Chest. 2005;128:881-895. [PubMed]
 
Beaulieu Y, Marik PE. Bedside ultrasonography in the ICU: part 2. Chest. 2005;128:1766-1781. [PubMed]
 

Figures

Tables

References

Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134:117-125. [PubMed] [CrossRef]
 
Kheir DE. One time comprehensive ultrasonography to diagnose deep vein thrombosis: is that the solution. Ann Intern Med. 2004;140:1052-1053. [PubMed]
 
Lichtenstein D, Mezière G, Biderman P, et al. The comet-tail artifact: an ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;156:1640-1646. [PubMed]
 
Beaulieu Y, Marik PE. Bedside ultrasonography in the ICU: part 1. Chest. 2005;128:881-895. [PubMed]
 
Beaulieu Y, Marik PE. Bedside ultrasonography in the ICU: part 2. Chest. 2005;128:1766-1781. [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543