Application of transthoracic lung ultrasound in the diagnosis of pulmonary edema at ICU patients – Literature review
More details
Hide details
Department of Anesthesiology and Intensive Care, Regional Specialized Hospital in Olsztyn, Poland
Department of General Surgery and Transplantology, Regional Specialized Hospital in Olsztyn, Poland
Department of Pediatric Orthopaedic and Trauma Surgery, Regional Specialized Hospital in Olsztyn, Poland
Submission date: 2016-05-24
Acceptance date: 2017-03-28
Online publication date: 2017-07-03
Publication date: 2020-03-22
Corresponding author
Paweł Grabala   

Department of Pediatric Orthopaedic and Trauma Surgery, Regional Specialized Children's Hospital in Olsztyn, Żołnierska 18A, 10-561 Olsztyn, Poland.
Pol. Ann. Med. 2017;24(2):300–303
Pulmonary edema (PED) is one of the potential causes of acute respiratory failure at ICU patients. Transthoracic lung ultrasound (TUS) is a useful method of evaluating the condition of the respiratory system, because especially in the critically ill patients, this study should be simple, fast and easily accessible. Hence the study design is simplified and presented as a treatment protocol known by the acronym BLUE (Lung Bedside Ultrasound in Emergency). Study under this scheme reduces testing time for even 1 min, and at the same time allows for the diagnosis of the causes of acute respiratory failure.

The aim of this work is to describe the basics of actual techniques of medical ultrasound for diagnosis PED.

Material and methods:
A literature review.

Results and discussion:
We presented how to identify with ultrasonography the most common types of PED at ICU patients.

Medical ultrasound is a simple, fast, cheap and reproducible method of evaluating the respiratory system and seems to be one of the most promising imaging techniques for the diagnosis of lung diseases and monitoring of respiratory functions.

Ware LB, Matthay MA. Acute pulmonary edema. N Engl J Med. 2005;353:2788–2796.
Kroegel C, Reissig A. Transthoracic Sonography. Principles and Application. An Introduction and Practical Guide. Stuttgart: Georg Thieme Verlag; 2000.
Olszewska J. Rehabilitation for chronic obstructive pulmonary disease patients. Pol Ann of Med. 2011;18(1):177–187.
Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134(1):117–125.
Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014;4(1):1.
Lichtenstein DA, Meziere G, Biderman P, Gepner A, Barré O. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;156(5):1640–1646.
Levitov A, Frankel HL, Blaivas M, et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients – Part II: Cardiac ultrasonography. Crit Care Med. 2016;44(6):1206–1227.
Gluecker T, Capasso P, Schnyder P, et al. Clinical and radiographics features of pulmonary oedema. Radiographics. 1999;19(6):1507–1531.
Staub NC. Pulmonary edema. Physiol Rev. 1974;54(3):678–811.
Manson WC, Bonz W, Carmody K, Osborne M, Moore CL. Identification of sonographic B-lines with linear transducer predicts elevated B-type natriuretic peptide level. West J Emerg Med. 2011;12(1):102–106.
Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577–591.
Agricola E, Bove T, Oppizzi M, et al. ‘Ultrasound comet-tail images’: a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water. Chest. 2005;127(5):1690–1695.
Noble VE, Murray AF, Capp R, Sylvia-Reardon MH, Steele DJ, Liteplo A. Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis. Time course for resolution. Chest. 2009;135(6):1433–1439.
Frassi F, Gargani L, Gligorova S. Clinical and echocardiographic determinants of ultrasound lung comets. Eur J Echocardiogr. 2007;8(6):474–479.
Liteplo AS, Marill KA, Villen T, et al. Emergency thoracic ultrasound in the differentiation of the etiology of shortness of breath (ETUDES): sonographic Blines and N-terminal pro-brain-type natriuretic peptide in diagnosing congestive heart failure. Acad Emerg Med. 2009;16(3):201–210.
Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008;6:16.
Bernard GR, Artigas A, Brigham KL. The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical coordination. Am J Respir Crit Care Med. 1994;149(3 Pt 1):818–824.
Yang PC, Luh KT, Chang DB, Yu CJ, Kuo SH, Wu HD. Ultrasonographic evaluation of pulmonary consolidation. Am Rev Respir Dis. 1992;146(3):757–762.
Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004;100(1):9–15.
Bouhemad B1, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med. 2011;183(3):341–347.
Bass CM, Sajed DR, Adedipe AA, West TE. Pulmonary ultrasound and pulse oximetry versus chest radiography and arterial blood gas analysis for the diagnosis of acute respiratory distress syndrome: a pilot study. Crit Care. 2015;19(1):282.
Zhao Z, Jiang L, Xi X, et al. Prognostic value of extravascular lung water assessed with lung ultrasound score by chest sonography in patients with acute respiratory distress syndrome. BMC Pulm Med. 2015;15:98.
Mączka AM, Kowalski IM, Onichimowski D. Pulmonary rehabilitation within intensive care units exemplified by traffic collisions casualties. Pol Ann Med. 2011;18(1):66–75.