{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:08:13Z","timestamp":1772168893490,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.19329.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2019,8,8]],"date-time":"2019-08-08T00:00:00Z","timestamp":1565222400000}}],"reference-count":6,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2019,8,8]],"date-time":"2019-08-08T00:00:00Z","timestamp":1565222400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>When using lung ultrasound to determine the cause of acute respiratory failure, the BLUE protocol is often used. In a 65-year old patient, an A\/B-profile was found, suggesting pneumonia, following the flowchart of this protocol. In this case, however, pulmonary hemorrhage confirmed by bronchoscopy was the final diagnosis. This case report outlines the importance of understanding the limitations of the BLUE protocol and that lung ultrasound findings should always be used in the context of the patient\u2019s history and physical exam. In addition, pulmonary hemorrhage should be considered in patients with no clinical signs of pneumonia and\/or presence of risk factors for lung bleeding as a rare cause of lung ultrasound A\/B-profile.<\/ns4:p>","DOI":"10.12688\/f1000research.19329.2","type":"journal-article","created":{"date-parts":[[2019,8,8]],"date-time":"2019-08-08T10:00:06Z","timestamp":1565258406000},"page":"788","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Pulmonary hemorrhage as a rare cause of lung ultrasound A\/B-profile"],"prefix":"10.12688","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2909-2175","authenticated-orcid":false,"given":"Mark E.","family":"Haaksma","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther J.","family":"Nossent","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Elbers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4335-5568","authenticated-orcid":false,"given":"Pieter Roel","family":"Tuinman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2019,8,8]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"117-25","DOI":"10.1378\/chest.07-2800","article-title":"Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol.","volume":"134","author":"D Lichtenstein","year":"2008","journal-title":"Chest."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"e707-e714","DOI":"10.1097\/CCM.0000000000003129","article-title":"Diagnostic Accuracy of Chest Radiograph, and When Concomitantly Studied Lung Ultrasound, in Critically Ill Patients With Respiratory Symptoms: A Systematic Review and Meta-Analysis.","volume":"46","author":"M Winkler","year":"2018","journal-title":"Crit Care Med."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"1265-1270","DOI":"10.1016\/j.amjcard.2004.02.012","article-title":"Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water.","volume":"93","author":"Z Jambrik","year":"2004","journal-title":"Am J Cardiol."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"689-696","DOI":"10.1016\/j.ajem.2006.02.013","article-title":"Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome.","volume":"24","author":"G Volpicelli","year":"2006","journal-title":"Am J Emerg Med."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"437-47","DOI":"10.1097\/ALN.0000000000000558","article-title":"Ultrasound for \"lung monitoring\" of ventilated patients.","volume":"122","author":"B Bouhemad","year":"2015","journal-title":"Anesthesiology."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"701-714","DOI":"10.1164\/rccm.201802-0236CI","article-title":"Lung Ultrasound for Critically Ill Patients.","volume":"199","author":"F Mojoli","year":"2019","journal-title":"Am J Respir Crit Care Med."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/8-788\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/8-788\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/8-788\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,8,28]],"date-time":"2019-08-28T07:10:14Z","timestamp":1566976214000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/8-788\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,8]]},"references-count":6,"URL":"https:\/\/doi.org\/10.12688\/f1000research.19329.2","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.22077.r52233","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.22077.r52233","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,8]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/8-788\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.22077.r52233, Belaid Bouhemad, Service d'Anesth\u00e9sie-R\u00e9animation Chirurgicale, CHU de Dijon, Dijon, France, 28 Aug 2019, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/8-788\/v2#referee-response-52233","order":0,"name":"referee-response-52233","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.21188.r49575, Daniel A. Lichtenstein, Medical Intensive Care Unit, Hospital Ambroise Par\u00e9, APHP, Paris-West University, Boulogne, France, 27 Jun 2019, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/8-788\/v1#referee-response-49575","order":1,"name":"referee-response-49575","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Mark Haaksma<\/b>; \n<i>Posted: 26 Jul 2019<\/i>; Dear Dr. Lichtenstein,&nbsp;Thank you for your time and expertise. We have adjusted the manuscript according to you feedback and would also like to respond to your comment.&nbsp;&nbsp;We would like to point out that this article was in no way meant to directly critique the BLUE-protocol. We ourselves are avid users of said protocol and ultrasound in general. The enthusiasm around it is, rightfully so, rapidly spreading. With it however, we have noticed that eagerness to quickly implement LUS in daily ICU practice comes with a lack of caution. Therefore, this article is meant as a reminder of certain caveats, which do not necessarily stem from the protocol but its implementation.&nbsp;We agree that in this instance the cause for respiratory failure was relatively clear and that application of the BLUE protocol was not called for. However, we believe with this clear-cut situation we underline our points given in the discussion and above. Point being that the high accuracy of the protocol should not lead physicians to a misplaced sense of security in more dubious cases. This again, is more as consequence of its implementation and not the protocol itself.&nbsp;&nbsp;In regard to image and probes we agree that the presented microconvex probe probably has various benefits over other probes that are frequently used. However, exactly the fact that various probes are being used is of great importance. Physicians should, yet sometimes might not be, aware of this. In our daily practice, we also see that there are differences in image quality depending on probes used.&nbsp;&nbsp;While we agree that \u201csimple\u201d LUS is sufficient for B-line assessment, we still believe that in the spirit of scientific curiosity we are obliged to research whether arising modalities such as 3D and doppler imaging might contribute to it. Perhaps new possibilities will present itself in this regard.Nevertheless, we want to thank you for your elaborate comment. It is without a doubt a good reminder and lesson of the BLUE-protocol for all readers.","URL":"https:\/\/f1000research.com\/articles\/8-788\/v2#referee-comment-4780","order":2,"name":"referee-comment-4780","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}