Title:Lung Ultrasound in the Critically Ill Neonate
Volume: 8
Issue: 3
Author(s): Daniel A. Lichtenstein and Philippe Mauriat
Affiliation:
Keywords:
BLUE-protocol, critical ultrasound, lung ultrasound, neonate intensive, care, pneumonia, pneumothorax,
pulmonary edema
Abstract: Critical ultrasound is a new tool for first-line physicians, including neonate intensivists. The consideration of
the lung as one major target allows to redefine the priorities. Simple machines work better than up-to-date ones. We use a
microconvex probe. Ten standardized signs allow a majority of uses: the bat sign (pleural line), lung sliding and the A-line
(normal lung surface), the quad sign and sinusoid sign indicating pleural effusion regardless its echogenicity, the tissuelike
sign and fractal sign indicating lung consolidation, the B-line artifact and lung rockets (indicating interstitial
syndrome), abolished lung sliding with the stratosphere sign, suggesting pneumothorax, and the lung point, indicating
pneumothorax. Other signs are used for more sophisticated applications (distinguishing atelectasis from pneumonia for
instance...). All these disorders were assessed in the adult using CT as gold standard with sensitivity and specificity
ranging from 90 to 100%, allowing to consider ultrasound as a reasonable bedside gold standard in the critically ill. The
same signs are found, with no difference in the critically ill neonate. Fast protocols such as the BLUE-protocol are
available, allowing immediate diagnosis of acute respiratory failure using seven standardized profiles. Pulmonary edema
e.g. yields anterior lung rockets associated with lung sliding, making the B-profile. The FALLS-protocol, inserted in a
Limited Investigation including a simple model of heart and vessels, assesses acute circulatory failure using lung artifacts.
Interventional ultrasound (mainly, thoracocenthesis) provides maximal safety. Referrals to CT can be postponed. CEURF
proposes personnalized bedside trainings since 1990. Lung ultrasound opens physicians to a visual medicine.
