Impact of the implementation of the BLUE protocol on mortality in patients with acute respiratory failure: our experience at the University Clinics of Kinshasa
Abstract
Background & objectives: Pulmonary ultrasound is an interesting tool for the etiological diagnosis of acute respiratory failure (ARF), but its impact has been little studied. We evaluated the impact of implementing Bedside Lung Ultrasound in Emergency (BLUE)-protocol on diagnosis and etiological treatment times, the proportion of imaging procedures performed, and mortality.
Methodology: A quasi-experimental ‘before–after’ study was conducted in the Emergency and Intensive Care Departments of the University Clinics of Kinshasa from April 1, 2023, to August 30, 2024. Pre-implementation phase entailed the prospective collection of data on patients admitted with acute respiratory failure (ARF). Data from 151 patients (99 before and 52 after the implementation of the BLUE protocol) were analyzed. Student’s t, Mann–Whitney, chi-squared, and Fisher’s exact tests were used, as well as logistic regression to identify factors associated with mortality (P < 0.05).
Results: The two groups were comparable in baseline characteristics. The time to etiological diagnosis ≤1 day increased significantly from 62.7% to 80.3% (P = 0.033). The time to etiological treatment ≤1 day also improved from 53.5% to 80.3% (P = 0.003). The use of chest X-rays decreased (48.5% vs. 9.6%, P = 0.01), while mortality remained unchanged (52.5% vs. 57.7%, P = 0.545).
Conclusion: Implementation of the BLUE protocol shortened diagnosis and treatment times and reduced ionizing imaging but did not significantly affect mortality.
Keywords: acute respiratory failure; BLUE protocol; lung ultrasound; mortality; quasi-experimental study.
Citation: Mbooto DMN, Amisi E, Bunkete AM, Mfulani G, Mbombo W, Muamba KA. et al. Impact of the implementation of the BLUE protocol on mortality in patients with acute respiratory failure: our experience at the University Clinics of Kinshasa. Anaesth. pain intensive care 2025;30(2):165-174. DOI: 10.35975/apic.v30i2.3122
Received: October 13, 2025; Revised: November 28, 2025; Accepted: November 29, 2025
