Abstract
In workshops, the lung sliding of healthy models is rather easy to study. In the critically ill, because either exacerbated but parasited by severe dyspneas or made too subtle by deep sedations, its study needs the consideration of adapted signs.
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References
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The A-profile. A standard lung sliding. See the ribs, the bat sign, and the pleural line, and note the sparkling at the pleural line, spreading below. Note also the A-line. Example of A-profile, indicating a normal lung surface. It is seen in healthy subjects and a group of diseases (pulmonary embolism, severe asthma, exacerbation of COPD, etc.). Above the pleural line, the parietal layers are quiet: no dyspnea (MOV 6550 kb)
Keye’s sign. COPD patient with marked dyspnea (36 breathings/minute). Lung sliding is difficult to see because of the muscular contractions. On M-mode (right), Keye’s space is parasited by this muscular activity. Lung sliding is however displayed, homogeneously filling the MM-space (MOV 6550 kb)
The effect of a summation filter. Standard lung sliding. Yet see how suddenly it gets markedly decreased, at the 6th second. The whole of the image is possibly “worked,” nice to see, but the lung sliding has quite vanished. The setting “SCC,” second line, has been activated (“1” if fully activated, “4” if not). Now, imagine a patient with a minimal lung sliding, plus such a filter: the condition for a difficult discipline is created (MOV 5855 kb)
The lung pulse. Patient with abolished lung sliding for any reason but not because of a pneumothorax. First, a B-line is visible. Second and mostly, even in its absence, a cardiac activity can be detected, 98 bpm. Example of lung pulse recorded at the right lower BLUE-point (MOV 3843 kb)
A stratosphere sign without pneumothorax. Young patient under mechanical ventilation for toxic coma. If looking carefully to the M-mode, lung sliding appears abolished, with a typical stratosphere sign. CEURF advises to always begin with the real time: a very discrete lung sliding can be visualized. No B-line is present, for helping. Sometimes (for not yet elucidated reasons), in spite of a M-mode shooting line at the center of the real-time image, a discrete lung sliding does not generate the expected seashore sign on the M-mode. We are between the pseudo-A’-profile and the A’-profile (as often in medicine). Note several points. Note that the filter “SCC” has been optimized, i.e., suppressed (position 4). Imagine that, if not, the real time should have never shown this minimal lung sliding. Note, at the bottom of the M-mode image, some sand is displayed (not exactly the Peyrouset phenomenon); this sand is far from the pleural line (unknown meaning, minor event). A comprehensive analysis would show the same pattern through the whole chest wall and above all no lung point. This additional detail prevents to wrongly evoke a pneumothorax. To summarize here: no pneumothorax (MOV 6511 kb)
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Lichtenstein, D.A. (2016). The A-Profile (Normal Lung Surface): 2) Lung Sliding. In: Lung Ultrasound in the Critically Ill. Springer, Cham. https://doi.org/10.1007/978-3-319-15371-1_10
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DOI: https://doi.org/10.1007/978-3-319-15371-1_10
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-15370-4
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