Can the Tomographic Aspect Characteristics of Patients Presenting with Acute Respiratory Distress Syndrome Predict Improvement in Oxygenation-related Response to the Prone Position?

Papazian, Laurent; Paladini, Marie-Héléne; Brégeon, Fabienne; Thirion, Xavier; Durieux, Olivier; Gainnier, Marc; Huiart, Laëtitia; Agostini, S; Auffray, Jean-Pierre

doi:10.1097/00000542-200209000-00013

Cited by 45 publications

(28 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…At the very end, the present lung US findings are consistent with two previous CT studies [9,10]. The change in oxygenation in the prone position did not correlate with either the static distribution of densities in the dorsal lung regions [10] or with lung recruitability in the supine position [9].…”

supporting

confidence: 91%

Assessment of oxygenation response to prone position ventilation in ARDS by lung ultrasonography

Guérin

Gattinoni

2016

Intensive Care Med

View full text Add to dashboard Cite

Acute respiratory distress syndrome (ARDS) is of major concern for the intensivist, as ARDS can only be treated in the intensive care unit (ICU). A cornerstone treatment is mechanical ventilation in order to buy time while the disease leading to ARDS can be cured. Therefore, the first aim of mechanical ventilation is to maintain a viable gas exchange. Over the years we realized that the cost of mechanical ventilation, as measured by the occurrence of ventilator-induced lung injury (VILI) [1], was too high if the target of the mechanical ventilation was normal blood gases. From there, permissive hypercapnia and oxygen saturation between 85 and 90 % were accepted to decrease the risk of VILI.To better tailor the ventilator settings, particularly to avoid potentially dangerous intratidal collapse and decollapse, increased attention was devoted to the characterization of the pathology underlying ARDS. To date, lung CT scan is the gold standard to assess the distribution of strain and from there to make inferences to minimize the occurrence of VILI. It should be mentioned, however, that no study demonstrated that patient outcome can be influenced from lung CT scan findings, essentially because no study has been done with this objective. Since ARDS lung characteristics cannot be monitored using CT imaging, methods feasible at the bedside are very attractive and lung ultrasound (US) is one of them [2]. One limitation of lung US is that the measurements do not quantify physical findings. Even though an aeration score has been developed, it is not quantitative as the Hounsfield units are for CT [3]. This US aeration score has been shown to correlate with PEEP-induced recruited lung volume obtained from the pressure-volume curve [4] and with weaning failure during spontaneous breathing trial [5]. Recently, however, it was shown that recruitment measured by CT scan (as re-inflation of previously not inflated regions) is not correlated with recruitment measured by the pressure-volume curve [6]. This last method and, by inference the US method, actually measure together both the aeration of previously non-aerated regions and a better inflation of lung regions already aerated. The regional hyperinflation, however, cannot be measured accurately either with CT (because of the mass increase of the ARDS lung) or lung US.Haddam et al.[7] performed a multicenter study in 51 ARDS patients with the aim to predict the oxygenation response to the prone position session from using lung US aeration score. The patients included suffered equally from either primary or secondary lung injury and received appropriate lung-protective mechanical ventilation. The authors found that changes in PaO 2 /F I O 2 ratio and lung aeration score did not correlate in either early or late stage of prone position regardless of the focal or nonfocal nature of ARDS. The same was true for changes in PaCO 2 . For the oxygenation to increase, and for the PaCO 2 to decrease, from increased regional lung aeration the blood should continue to flow towards those rea...

show abstract

supporting

confidence: 91%

Assessment of oxygenation response to prone position ventilation in ARDS by lung ultrasonography

Guérin

Gattinoni

2016

Intensive Care Med

View full text Add to dashboard Cite

show abstract

“…At variance with previous studies [20,24,25], our findings were confirmed over the PP session, corresponding to a persistent response. Improving oxygenation by PP is supported by several mechanisms, as previously described [4,26,27].…”

Section: Oxygenation Response To Ppcontrasting

confidence: 63%

“…The predominance of aeration loss in dependent and dorsal lung areas measured by CT scan did not influence the response to PP [20]. Our study confirms that lung morphology does not predict response to PP in terms of oxygenation.…”

Section: Oxygenation Response To Ppsupporting

confidence: 48%

See 1 more Smart Citation

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

Haddam

Zieleskiewicz

Parratte³

et al. 2016

Intensive Care Med

Self Cite

107

View full text Add to dashboard Cite

show abstract

“…Fourth, since the authors used the highest lung score for each of the 12 lung zones they evaluated, even a diffuse pattern may include considerable heterogeneity, as reported in previous studies of lung ultrasound and ARDS (24). Finally, even if lung ultrasound successfully detected changes in aeration, prior studies utilizing CT have shown that aeration changes are not sufficient to identify which patients will have improvements in gas exchange (29).…”

Section: Commentarymentioning

confidence: 98%

Lung ultrasound in acute respiratory distress syndrome and beyond

Baston¹,

West²

2016

J. Thorac. Dis.

View full text Add to dashboard Cite

Can the Tomographic Aspect Characteristics of Patients Presenting with Acute Respiratory Distress Syndrome Predict Improvement in Oxygenation-related Response to the Prone Position?

Abstract: There are no distinctive morphologic features in the pattern of lung disease measured by computed tomographic scanning performed with the patient in the supine position that can predict response to the prone position.

Cited by 45 publications

References 18 publications

Assessment of oxygenation response to prone position ventilation in ARDS by lung ultrasonography

Assessment of oxygenation response to prone position ventilation in ARDS by lung ultrasonography

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

Lung ultrasound in acute respiratory distress syndrome and beyond

Contact Info

Product

Resources

About