Monday, February 22, 2021

BLUE and FALLS protocol

 Q: What are the BLUE and FALLS protocols in respiratory failure?


Ultrasound in emergency (BLUE) and fluid administration limited by lung sonography (FALLS) are systemic and algorithmic approaches to perform thoracic ultrasound in acute respiratory failure. They examine well-defined points on both sides of the thorax i.e., anterior, lateral, and posterolateral. They are easy bedside procedures but powerful tool to determine the etiology of respiratory failure. BLUE protocol, if performed properly, is found to be 90% accurate to diagnose pneumonia, CHF, COPD, asthma, PE, and pneumothorax. 

They can be performed together. They look for five main processes: 

 1. Normal lung surface 
  •  bat sign 
  • lung sliding A-lines 
 2. Pleural effusions 
  •  quad sign 
  • sinusoid sign 
 3. Lung consolidations 
  •  fractal 
  •  tissue-like sign 
 4. Interestial syndrome
  •  lung rockets 
 5. Pneumothorax 
  • stratosphere sign
  • lung point 



1. Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015 Jun;147(6):1659-1670. doi: 10.1378/chest.14-1313. PMID: 26033127. 

2. Lichtenstein D. Lung ultrasound in the critically ill. Curr Opin Crit Care 2014; 20:315.

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