Lung Ultrasound: A Tool Which Contributes in Making Critical Ultrasound a Holistic Discipline and Maybe a Philosophy

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Hôpital Ambroise Paré Service de Réanimation Médicale, Boulogne (Paris-West University), France

Critical ultrasound is a bit more than a new tool – it is also a philosophy. Created from 1912 events (the sonar, born from the Titanic wreckage), adapted to the patient in the year 1950, adapted to the critically ill in the early 1990s, and becoming widely appreciated these recent years, lung ultrasound in the critically ill – LUCI – should first be considered through scientific appraisals: life savings, cost savings, and evidence-based medicine, which would definitely prove its value. It may also be considered a bit of a philosophy. The saved time, the spared irradiation, the increased comfort to the patient, and the comfort of the clinician facing critical situations, so to speak this kind of elegance used around the concept of point-of-care medicine, cannot be scientifically measured and are maybe as important.

To make ultrasound a kind of philosophy is a lesser problem. Some would love to make it a religion, and we should feel flattered to see our life’s work turned into such a mystic glow. Yet if it is considered as a “religion” more than a tool, human factors may appear and uncontrolled events can happen. Blindness to some limitations and fights for power, all these obscure points would spoil its spirit. Critical ultrasound, lung ultrasound, BLUE-protocol, etc., are just tools. Powerful, elegant, allowing to see acute dramas through a visual approach it is true, but just tools, with limitations.

As regards LUCI, which is a major part of critical ultrasound (at least, our opinion!), most of these limitations could be taught from reading existing experience. Some will appear in the battlefield, since they are not yet known (probably because of their rarity), but this perspective should bring humility – and caution – in the concept. Conversely, we fully admit that we feel the triumph of simplicity in each case where LUCI is used instead of the giants of modern imaging (the newest multislice CT generations, RMI, sophisticated echocardiography) and answers the clinical question: one small drop of a philosophy. Again attached to this idea, this textbook could have been written in 1982; the ADR-4000 was at this remote period a perfect tool. Those who remain persuaded that CT is “fast” should see that (our) ultrasound is the fastest of all tools in medical imaging.

What is holistic ultrasound, by the way? This is maybe the time here to define this term we used countless times throughout the textbook! Far from mystical definitions, a discipline is holistic when the understanding of each of its components is necessary for understanding the whole. Each component interacts with the others, hence, this (rather) thick book. The word “harmony” should rule holistic ultrasound: one simple unit; one single probe, but not any probe (a microconvex) (our Japanese microconvex probe more precisely); the lung at the center of our use; a logic adapted to a visual medicine with the humble aim of simplifying critical care.

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