Evaluation of density area in dorsal lung region during prone position using transesophageal echocardiography

Tsubo, Toshihito; Yatsu, Yuichi; Tanabe, T.; Okawa, Hirobumi; Ishihara, Hironori; Matsuki, Akitomo

doi:10.1097/01.ccm.0000104944.18636.b2

Cited by 28 publications

(21 citation statements)

References 17 publications

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“…Transthoracic lung ultrasound has several advantages over conventional radiological means for assessing lung aeration: it is reliable and accurate (17,18,23), highly reproducible (34), noninvasive, and easily repeatable at the bedside. Several studies have demonstrated that lung ultrasound is accurate for assessing positive end-expiratory pressure and prone position-induced lung recruitment (17,(35)(36)(37), lung reaeration following antimicrobial therapy in ventilator-associated and communityacquired pneumonia (18), and lung reaeration associated with resolution of various forms of pulmonary edema (38)(39)(40)(41)(42)(43)(44). Although the ultrasound detection of SBT-induced lung derecruitment does not give any indication about the cause of aeration loss, upper airway obstruction, persisting pneumonia, congestive heart failure, aspiration of secretions, cough inefficient to remove excessive bronchial secretions, and muscle weakness as observed in critically ill patients with polyneuropathy, it can be used as a predictor of extubation failure.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress*

Soummer

Parratte

Brisson

et al. 2012

Critical Care Medicine

406

362

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Section: Discussionmentioning

confidence: 99%

Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress*

Soummer

Parratte

Brisson

et al. 2012

Critical Care Medicine

406

362

View full text Add to dashboard Cite

show abstract

“…Gattinoni et al described that, when body position was changed from supine to prone, there was a dramatic redistribution of lung densities from the dorsal to the ventral visualized by CT [4]. Additionally, transesophageal echocardiography (TEE) has been used to observe the change in density area while patients were in PP [12]. However, both CT and TEE are not easily accessible in clinical practice.…”

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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“…In patients on mechanical ventilation, US can be considered a reliable method to detect nonaerated lung regions [16]. Previous studies have shown the utility of US in the detection and quantification of lung recruitment via a transesophageal approach [17-19] and only recently via a transthoracic approach [20]. …”

Section: Introductionmentioning

confidence: 99%

Lung sonography and recruitment in patients with early acute respiratory distress syndrome: A pilot study

et al. 2011

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IntroductionBedside lung sonography is a useful imaging tool to assess lung aeration in critically ill patients. The purpose of this study was to evaluate the role of lung sonography in estimating the nonaerated area changes in the dependent lung regions during a positive end-expiratory pressure (PEEP) trial of patients with early acute respiratory distress syndrome (ARDS).MethodsTen patients (mean ± standard deviation (SD): age 64 ± 7 years, Acute Physiology and Chronic Health Evaluation II (APACHE II) score 21 ± 4) with early ARDS on mechanical ventilation were included in the study. Transthoracic sonography was performed in all patients to depict the nonaerated area in the dependent lung regions at different PEEP settings of 5, 10 and 15 cm H2O. Lung sonographic assessment of the nonaerated lung area and arterial blood gas analysis were performed simultaneously at the end of each period. A control group of five early ARDS patients matched for APACHE II score was also included in the study.ResultsThe nonaerated areas in the dependent lung regions were significantly reduced during PEEP increases from 5 to 10 to 15 cm H2O (27 ± 31 cm2 to 20 ± 24 cm2 to 11 ± 12 cm2, respectively; P < 0.01). These changes were associated with a significant increase in arterial oxygen partial pressure (74 ± 15 mmHg to 90 ± 19 mmHg to 102 ± 26 mmHg; P < 0.001, respectively). No significant changes were observed in the nonaerated areas in the dependent lung regions in the control group.ConclusionsIn this study, we show that transthoracic lung sonography can detect the nonaerated lung area changes during a PEEP trial of patients with early ARDS. Thus, transthoracic lung sonography might be considered as a useful clinical tool in the management of ARDS patients.

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Evaluation of density area in dorsal lung region during prone position using transesophageal echocardiography

Abstract: It was possible to observe the change in density area during prone position using transesophageal echocardiography. The change of density area estimated with transesophageal echocardiography during prone position was useful to estimate the effectiveness of the procedure.

Cited by 28 publications

References 17 publications

Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress*

Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress*

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

Lung sonography and recruitment in patients with early acute respiratory distress syndrome: A pilot study

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