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

Haddam, Malik; Zieleskiewicz, Laurent; Parratte, Sébastien; Baldovini, Alice; Guervilly, Christophe; Arbelot, Charlotte; Noel, Alexandre; Vigne, Coralie; Hammad, Emmanuelle; Antonini, François; Lehingue, Samuel; Peytel, E.; Lü, Qin; Bouhemad, Bélaïd; Golmard, Jean‐Louis; Langeron, Olivier; Martin, Claude; Muller, Laurent; Rouby, Jean‐Jacques; Constantin, Jean-Michel; Papazian, Laurent; Léone, Marc

doi:10.1007/s00134-016-4411-7

Cited by 101 publications

(100 citation statements)

References 41 publications

(68 reference statements)

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“…In conclusion, lung US allows monitoring of lung aeration at the bedside and the present results [7] are the expression of a negative control group: it was expected that lung US aeration score would not correlate with changes in gas exchange and this is what was found.…”

supporting

confidence: 55%

“…The present results may indicate that in the subset of patients investigated by Haddam et al [7] the pulmo-nary blood flow was diverted away the reaerated lung regions in the prone position. This is not in line with the fact that the pulmonary blood flow continues to prevail in the dorsal regions in the prone position, as observed in many animal studies [8].…”

supporting

confidence: 49%

“…• The second reason is that lung US aeration score does not measure reaeration accurately, although the lung US findings found by Haddam et al [7] are qualitatively in line with the lung CT findings (increased aeration in dorsal lung regions associated with a decreased in aeration in ventral lung regions in the prone position).…”

mentioning

confidence: 92%

“…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.…”

mentioning

confidence: 99%

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

Guérin

Gattinoni

2016

Intensive Care Med

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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...

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supporting

confidence: 55%

supporting

confidence: 49%

mentioning

confidence: 92%

mentioning

confidence: 99%

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

Guérin

Gattinoni

2016

Intensive Care Med

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“…Currently, the gold standard for assessing regional atelectasis is a CT scan, but it is limited by costs, risks of transportation, and radiation exposure. In a recent study, Haddam et al evaluated whether lung ultrasound could predict which patients with ARDS would most improve their gas exchange after prone positioning (28). They serially evaluated the lung abnormalities seen on ultrasound in each of 12 lung zones before, during, and after prone positioning in order to calculate discrete regional and global aeration scores at each timepoint, change in discrete scores (reaeration scores) with change in positioning, and to categorize patients with focal ARDS.…”

Section: Commentarymentioning

confidence: 99%

Lung ultrasound in acute respiratory distress syndrome and beyond

Baston¹,

West²

2016

J. Thorac. Dis.

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Expert consensus document: Reporting checklist for quantification of pulmonary congestion by lung ultrasound in heart failure

Platz

Jhund

Girerd

et al. 2019

European J of Heart Fail

101

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Lung ultrasound is a useful tool for the assessment of patients with both acute and chronic heart failure, but the use of different image acquisition methods, inconsistent reporting of the technique employed and variable quantification of 'B-lines,' have all made it difficult to compare published reports. We therefore need to ensure that future studies utilizing lung ultrasound in the assessment of heart failure adopt a standardized approach to reporting the quantification of pulmonary congestion. Strategies to improve patient care by use of lung ultrasound in the assessment of heart failure have been difficult to develop. In the present document, key aspects of standardization are discussed, including equipment used, number of chest zones assessed, the method of quantifying B-lines, the presence and timing of additional investigations (e.g. natriuretic peptides and echocardiography) and the impact of therapy. This consensus report includes a checklist to provide standardization in the preparation, review and analysis of manuscripts. This will serve as a guide for investigators and clinicians and enhance the quality and transparency of lung ultrasound research.

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

Abstract: In ARDS patients with a PaO2/FiO2 ratio ≤150 mmHg, bedside LUS cannot predict oxygenation response after the first PP session. At the bedside, LUS enables monitoring of aeration changes during PP.

Cited by 101 publications

References 41 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 ultrasound in acute respiratory distress syndrome and beyond

Expert consensus document: Reporting checklist for quantification of pulmonary congestion by lung ultrasound in heart failure

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