Can lung ultrasonography predict prone positioning response in acute respiratory distress syndrome patients?

Prat, Gwénaël; Guinard, Solène; Bizien, Nicolas; Nowak, Emmanuel; Tonnelier, Jean-Marie; Alavi, Zarrin; Renault, Anne; Boles, Jean-Michel; L’Her, Erwan

doi:10.1016/j.jcrc.2015.12.015

Cited by 46 publications

(37 citation statements)

References 28 publications

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“…Before initiating PP, bedside LUS did not differentiate the two groups in contrast with a previous study [33]. In the supine position, a normal pattern of anterobasal regions was associated with the oxygenation response.…”

Section: Oxygenation Response To Ppcontrasting

confidence: 96%

Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS

Haddam

Zieleskiewicz

Parratte³

et al. 2016

Intensive Care Med

100

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Section: Oxygenation Response To Ppcontrasting

confidence: 96%

Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS

Haddam

Zieleskiewicz

Parratte³

et al. 2016

Intensive Care Med

100

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“…Haddam et al found that oxygenation response after PP was not correlated with a specific LUS pattern [5], whereas Prat et al found that a normal LUS pattern of both anterobasal lung regions in supine position may predict a significant P/F ratio improvement [19]. One of the possible reasons for that difference was both of the studies chose oxygenation improvement as the index of the response, and we found that the oxygenation improvement did not correlate with the improvement in lung aeration.…”

Section: Discussionmentioning

confidence: 99%

Lung ultrasound can be used to predict the potential of prone positioning and assess prognosis in patients with acute respiratory distress syndrome

et al. 2016

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BackgroundIt is very important to assess the effectiveness of prone positioning (PP) in patients with severe acute respiratory distress syndrome (ARDS). However, it is difficult to identify patients who may benefit from PP. The purpose of this study was to investigate whether prone positioning potential (PPP) can be predicted by lung ultrasound in patients with ARDS.MethodsIn this prospective study, 45 patients with ARDS were included for the assessment of PPP. A PP lung ultrasound examination (PLUE) protocol was performed in the dorsal regions of the lung in 16 areas at H0, H3, and H6 (0, 3, and 6 h after PP). The ultrasonography videos were blindly evaluated by two expert clinicians to classify the lung regions as normal pattern (N), moderate loss of lung aeration (B1), severe loss of lung aeration (B2), and consolidation (C). The aeration scores were collected at H0, H3, and H6. According to the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (P/F ratio) at 7 days, patients were classified into PPP-positive (P/F ratio >300) and PPP-negative groups; also, the patients were classified into survival and nonsurvival groups according to 28-day mortality.ResultsAeration scores was compared at H0, H3, and H6. The scores were significantly reduced between H3 and H0, but there was no difference between H3 and H6. The aeration score variation (ASV) of the PPP-positive group between H3 and H0 was significantly higher than that in the PPP-negative group, and the sensitivity and specificity of ASV ≥5.5 for the PPP-positive group were 73.9% and 86.4%, respectively. The area under the receiver operating characteristic curve (AUROC) was 0.852 for the ASV. The ASV between H3 and H0 in the survival group was significantly higher than in the nonsurvival group. The sensitivity and specificity of ASV ≥7 for survival were 51.5% and 75%, respectively. The AUROC was 0.702 for the ASV.ConclusionsThe PLUE protocol can be used to predict PPP and assess prognosis in patients with ARDS.

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“…Static compliance during PP session increased from 23 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) to 27 (20-37) mL/cmH 2 O (P < 0.01), corresponding to a VT and a corrected minute ventilation increase from 4.2 (3.3-5.4) to 5.6 (3.8-6.4) mL/kg and 5.5 (4.3-6.8) to 6.2 (5.1-6.9) L/min (P = 0.04), respectively. Consequently, local compliance variations, which is calculated based on local impedance variation compared to baseline, increased by 120 (60-180) % at the end of PP (Fig.…”

Section: Static Global Compliance Local Compliance Variation and Gasmentioning

confidence: 99%

“…We rather chose to analyze the PP impact on respiratory mechanics, using compliance to evaluate PP response. We performed a subgroup analysis differentiating patients with a compliance gain (PCG+) after 16 h of PP, defined by an increase ≥ 3 mL/cmH 2 O compared to baseline (i.e., SP) [9,10,29], and patients with no compliance gain (PCG−). We arbitrarily chose that definition by considering that a VT increase of > 40 mL after PP would be more likely to represent a "true" compliance gain rather than an inherent measurement variability, which could not be excluded with a smaller VT increase on ECMO.…”

Section: Evaluation Of Pp Responsementioning

confidence: 99%

Prone positioning monitored by electrical impedance tomography in patients with severe acute respiratory distress syndrome on veno-venous ECMO

Franchineau

Bréchot

Hékimian

et al. 2020

Ann. Intensive Care

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Background: Prone positioning (PP) during veno-venous ECMO is feasible, but its physiological effects have never been thoroughly evaluated. Our objectives were to describe, through electrical impedance tomography (EIT), the impact of PP on global and regional ventilation, and optimal PEEP level. Methods:A monocentric study conducted on ECMO-supported severe ARDS patients, ventilated in pressurecontrolled mode, with 14-cmH 2 O driving pressure and EIT-based "optimal PEEP". Before, during and after a 16-h PP session, EIT-based distribution and variation of tidal impedance, VT dorsal /VT global ratio, end-expiratory lung impedance (EELI) and static compliance were collected. Subgroup analyses were performed in patients who increased their static compliance by ≥ 3 mL/cmH 2 O after 16 h of PP.Results: For all patients (n = 21), tidal volume and EELI were redistributed from ventral to dorsal regions during PP. EIT-based optimal PEEP was significantly lower in PP than in supine position. Median (IQR) optimal PEEP decreased from 14 (12-16) to 10 (8-14) cmH 2 O. Thirteen (62%) patients increased their static compliance by ≥ 3 mL/cmH 2 O after PP on ECMO. This subgroup had higher body mass index, more frequent viral pneumonia, shorter ECMO duration, and lower baseline VT dorsal /VT global ratio than patients with compliance ≤ 3 mL/cmH 2 O (P < 0.01). Conclusion:Although baseline tidal volume distribution on EIT may predict static compliance improvement after PP on ECMO, our results support physiological benefits of PP in all ECMO patients, by modifying lung mechanics and potentially reducing VILI. Further studies, including a randomized-controlled trial, are now warranted to confirm potential PP benefits during ECMO.

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Can lung ultrasonography predict prone positioning response in acute respiratory distress syndrome patients?

Cited by 46 publications

References 28 publications

Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS

Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS

Lung ultrasound can be used to predict the potential of prone positioning and assess prognosis in patients with acute respiratory distress syndrome

Prone positioning monitored by electrical impedance tomography in patients with severe acute respiratory distress syndrome on veno-venous ECMO

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