Daniel Lichtenstein

Hospital Ambroise Paré, Paris-West university, France

Title: TBA

---

Biography

Daniel Lichtenstein is medical intensivist, Ambroise-Paré Hospital (Paris). Defined critical ultrasound since 1985 (Intensive Care Med 1991;19:353-355) describing diagnoses, immediate therapies, procedures (venous canulation, thoracentesis...) in a holistic approach, favoring simple equipment, one universal probe for whole body, emphasis on lung, simple cardiac sonography (and others), extrapolable to multiple disciplines (pediatry, pulmonology...), settings (ICU, austere areas...), patients (from bariatric to neonates). One textbook (1992, 2002, 2005, 2010, 2011, 2016 editions, Springer-Verlag), original articles including: BLUE-protocol (acute respiratory failure), FALLS-protocol (lung ultrasound in circulatory failure), SESAME-protocol (cardiac arrest), lung ultrasound in neonates. President of CEURF (training center at bedside in I.C.U.).

Abstract

Critical ultrasound was defined in our 1991 publication: “ultrasound for the critically ill, by the critical care physician, whole body ultrasound”. This definition considers the lung, providing a new definition of ultrasound (a visual medicine).
The BLUE-protocol is a fast protocol enabling immediate diagnosis of acute respiratory failure. We use a 1992, gray-scale unit, a microconvex probe. The BLUE-protocol analyzes ten signs: bat sign (pleural line), lung sliding, A-lines (horizontal artifacts arising from pleural line), quad sign and sinusoid sign indicating pleural effusion, fractal sign and lung sign indicating lung consolidation, B-lines (particular comet-tail artifacts arising from the pleural line among seven criteria), and lung rockets (multiple B-lines, indicating interstitial syndrome), abolished lung-sliding with stratosphere sign, suggesting pneumothorax, lung point indicating pneumothorax. Pulmonary edema, pneumothorax, pulmonary embolism, pneumonia, COPD, asthma, were assessed using CT (gold standard) with sensitivity and specificity ranging from 90 to 100%1.
The B-profile is the name given to the association of lung-rockets with lung-sliding, symmetrical at the anterior chest wall, without any anterior consolidation. The B-profile is 97% sensitive and 95% specific to hemodynamic pulmonary edema1. The A-line indicates non elevated PAOP2. The BLUE-protocol is a holistic protocol, because it allows estimation of left heart function in numerous settings (critically ill to ambulatory patient, neonates to seniors, wealthy to scarse-resource areas).
Shortly, derived products. The FALLS-protocol2 uses, in acute circulatory failure, the B-line as direct parameter of clinical volemia and endpoint for fluid therapy. Cardiac arrest3.
CEURF trains since 1989 at the bedside in our ICU.