POCUS FOR RSEPIRATORY SYSTEM

DR TANVIR HUSSAIN
FCPS ANESTHESIOLOGY
FCPS CRITICAL CARE MEDICINE
KAUL ASSOCIATES
 POCUS
 Point of care ultrasound refers to the use of ultrasound at a
patient's bedside for diagnostic or therapeutic purposes. A
clinician uses point of care ultrasound (POCUS) to guide the
evaluation and diagnosis in conjunction with a traditional medical
examination.
 LUNG ULTRASOUND
 Its application at the bedside includes differential diagnosis and therapeutic management of complex clinical
pictures, such as :
 Assessment of acute respiratory failure
 Assessment of acute circulatory failure and cardiac arrest
 Assessment of Lung aeration and de-aeration
 Mechanical ventilation
 LUNG Semiotics
 The Bat sign
Lung Sliding
Seashore sign
Lung pulse
Stratosphere sign
Lung Point
The A-line
B- lines
Quad sign
Sinusoid sign
Fractal sign
Tissue like sign
Air Bronchogram
 Assessment of Acute Respiratory Failure
 Common causes of Acute Respiratory Failure are Acute
Pulmonary Edema, Acute Exacerbation of COPD or Asthma,
Pulmonary Embolism, Pneumonia, Pneumothorax and ARDS.
 These diseases can be early diagnosed and managed with the
help of POCUS using BLUE protocol.
 BLUE Protocol
 The BLUE-protocol combines signs, associates them with a location, resulting in seven profiles
BLUE Points
 The A-profile associates anterior lung-sliding with A-lines.
 The A’-profile is an A-profile with abolished lung-sliding.
 The B-profile associates anterior lung-sliding with lung-rockets.
 The B’-profile is a B-profile with abolished lung-sliding.
 The C-profile indicates anterior lung consolidation, regardless of size and number. A thickened, irregular
pleural line is an equivalent.
 The A/B profile is a half A-profile at one lung, a half B-profile at another.
 The PLAPS Profile
 Assessment of Circulatory Failure and Cardiac Arrest

 A combined ultrasound assessment of the right ventricle, the inferior vena cava, and the lung can rapidly rule
out causes of obstructive shock, such as substantial pericardial effusion, acute cor pulmonale, or
pneumothorax.
 Left cardiogenic shock can be ruled in or out depending on the presence or absence of a diffuse homogeneous
B-pattern.
 The change from A-lines to B-pattern under fluid therapy early identifies lung extravascular leakage in patients
with ARDS with septic shock and indicates that fluid therapy should be discontinued.
 Assessment of Lung Aeration and De Aeration

Lung Ultrasound Score

 Predicts ARDS Mortality and Weaning Failure

 Allows monitoring aeration in patients receiving ECMO and fluid

resuscitation
 Allows monitoring of VAP response to antibiotics and PEEP

induced recruitment
 Allow distinguishing pronation position responders from non

responders
Lung ultrasound guided mechanical ventilation
 It may help airway management.
 It may help to distinguish between PEEP responders and non responders
 It helps early detection of common complications of mechanical ventilation, such as Pleural effusion, Alveolar
consolidation related to atelectasis or VAP, Pneumothorax.