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

Abstract

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.

Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review

“…In 45 patients with moderate to severe ARDS, Wang et al found that a reduction of 5.5 points or higher in the lung US score for dependent lung regions in the prone position (3 hours after prone positioning) correlated with a Pa o 2 /Fi o 2 ratio of greater than 300 after 7 days (prone positioning potential–positive group), and those with a lung US score reduction of 7 or higher correlated with improved survival. The authors did not find a correlation between the lung US score variation and oxygenation at 3 hours after prone positioning, but they did find a significant improvement in the dead space .…”

Semiquantititative lung ultrasound scores are accurate and useful in critical care, irrespective of patients’ ages: The power of data over opinions

“…In conclusion, while providing unessential or dangerous statements, this Commentary seems to overlook the strong evidence behind the use of semiquantitative LUS in critically ill patients of any age. In fact, several US scores, carrying all of the intrinsic characteristics due to their semiquantitative nature and being even simpler than the neonatal one, have been validated against a multitude of techniques (Table ), confirming their usefulness despite their intrinsic limitations . Table is not comprehensive, but it is out of the scope of this article to list all LUS validation studies.…”

Intubation and Ventilation amid COVID-19: Comment

“…In this regard, chest computed tomography cannot be routinely used in daily clinical practice to monitor aeration improvement, while lung ultrasonography represents a valid bedside alternative for this purpose. 5 Indeed, ultrasound could be a viable option to reduce the need to transport patients to the radiology department, reducing the exposure of hospital staff and other subjects to COVID-19 patients. Pan et al have recently highlighted that lung recruitability can be effectively assessed bedside in COVID-19 patients with ARDS.…”

“…2 Similar results were presented by Wang et al, who reported that bedside lung ultrasonography can be adopted to guide response to prone positioning. 5 It is important to remember that the use of positive pressure cycles remains associated with potential adverse effects such as an increased risk of unintended extubation and/or secondary hemodynamic effects, and the real impact of this strategy in COVID-19 patients with previous cardiac disease remains unknown. For these reasons, the use of lung ultrasound could further implement the use of a personalized approach to the ARDS management and related ventilatory support.…”

“…4 Last, lung ultrasonography facilitates the determination of the duration and frequency of prone position ventilation. 5 It assesses the effectiveness of lung recruitment of the gravity-dependent areas. The aeration of the inferior anterior lungs may representatively predict the effectiveness of ventilation-perfusion matching and the potential of oxygenation improvement.…”