LICHTENSTEIN Daniel

Daniel LICHTENSTEIN

Intensive Care Unit, Hospital Ambroise-Paré, Boulogne (Paris-West University), France

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The integration of lung ultrasound in the critically ill（LUCI）in critical ultrasound provides a new definition of the priorities. We need a simple equipment, and use a 1992 Japanese technology, a simple gray-scale unit without Doppler and a microconvex probe. Some manufacturers begin to come back to this technology, fortunately.
The ten main signs are the bat sign（indicating pleural line）, lung sliding（yielding the seashore sign）, the A-line（horizontal artifact）, the quad and sinusoid sign indicating pleural effusion（regardless its echogenicity）, the tissue-like sign and the shred sign indicating lung consolidation, the B-line and the lung rockets（vertical artifacts indicating interstitial syndrome）, abolished lung sliding with the stratosphere sign, suggesting pneumothorax, and the lung point, indicating pneumothorax. All these disorders were assessed using CT scan as a gold standard with sensitivity and specificity ranging from 90 to 100％，allowing to consider LUCI as a reasonable bedside gold standard in the critically ill.
Major applications are the possibility to postpone referral to CT（in ARDS, mainly）. The immediate diagnosis of an acute respiratory failure（BLUE-protocol）. A direct parameter of clinical volemia, of interest in the management of acute circulatory failure（FALLS-protocol）. The mastery of reversible causes of cardiac arrest, pneumothorax first（SESAME-protocol）. Its use in neonates（the signs being the same than in the adult）, trauma, ICU, austere or remote areas. Last, the LUCIFLR project generates major decrease in irradiation. LUCI allows to simplify other fields such as echocardiography, one example showing how LUCI is a holistic discipline.