Lung ultrasound can predict response to the prone position in awake non-intubated patients with COVID‑19 associated acute respiratory distress syndrome

Avdeev, S. N.; Nekludova, Galina; Trushenko, Natalia V.; Tsareva, Natalia A.; Yaroshetskiy, Andrey I.; Kosanovic, Djuro

doi:10.1186/s13054-021-03472-1

Cited by 25 publications

(26 citation statements)

References 6 publications

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“…There was only three studies that categorized prone position effect as responders and nonresponders [ 8 ▪▪ , 9 ▪▪ , 32 ]. The definition of responders was variable, such as prepost prone lung ultrasound (LUS) score reduction, PaO 2 increase and SpO 2 /FiO 2 increase.…”

Section: Resultsmentioning

confidence: 99%

Prone position in COVID 19-associated acute respiratory failure

Kharat

Simon

Guérin

2021

Current Opinion in Critical Care

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Purpose of review Prone position has been widely used in the COVID-19 pandemic, with an extension of its use in patients with spontaneous breathing (’awake prone’). We herein propose a review of the current literature on prone position in mechanical ventilation and while spontaneous breathing in patients with COVID-19 pneumonia or COVID-19 ARDS. Recent findings A literature search retrieved 70 studies separating whether patient was intubated (24 studies) or nonintubated (46 studies). The outcomes analyzed were intubation rate, mortality and respiratory response to prone. In nonintubated patient receiving prone position, the main finding was mortality reduction in ICU and outside ICU setting. Summary The final results of the several randomized control trials completed or ongoing are needed to confirm the trend of these results. In intubated patients, observational studies showed that responders to prone in terms of oxygenation had a better survival than nonresponders.

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Section: Resultsmentioning

confidence: 99%

Prone position in COVID 19-associated acute respiratory failure

Kharat

Simon

Guérin

2021

Current Opinion in Critical Care

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“…In a second study, aeration changes in posterior fields induced by the first 3 h of prone positioning were significantly greater in patients with positive responses and associated with greater levels of oxygenation after 7 days of treatment. Moreover, the lung aeration changes correlated well with the reduction in dead space [ 85 ]. Rousset et al confirm that prone responders present a greater LUS reaeration score at both an early and late stage of prone positioning, corresponding with an increase in end-expiratory lung volume [ 82 ].…”

Section: Resultsmentioning

confidence: 99%

“…Rousset et al confirm that prone responders present a greater LUS reaeration score at both an early and late stage of prone positioning, corresponding with an increase in end-expiratory lung volume [ 82 ]. Similarly, in COVID-19 pneumonia, the improvement in oxygenation following pronation was associated with an improvement in both the global and posterior LUS scores [ 85 ]. LUS was proven to be a reliable bedside tool for monitoring lung aeration across the different phases of prone positioning in ARDS patients undergoing invasive mechanical ventilation.…”

Section: Resultsmentioning

confidence: 99%

Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO)

Vetrugno

Mojoli

Cortegiani

et al. 2021

J Anesth Analg Crit Care

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Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients.

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“…Second, the study population was not standardized for the COVID-19 ARDS phenotype or disease history and thus NIV might have been applied in patients with different lung involvements. Third, diaphragmatic and lung ultrasound were performed at baseline in supine position and after 1 h following prone position application, as also recently proposed in COVID-19 patients for sonographic assessment of lung aeration alone [37]. Different results might be obtained at different timepoints, i.e., 3-6 h from prone positioning onset as otherwise proposed [38].…”

Section: Discussionmentioning

confidence: 99%

Effect of awake prone position on diaphragmatic thickening fraction in patients assisted by noninvasive ventilation for hypoxemic acute respiratory failure related to novel coronavirus disease

et al. 2021

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Background Awake prone position is an emerging rescue therapy applied in patients undergoing noninvasive ventilation (NIV) for acute hypoxemic respiratory failure (ARF) related to novel coronavirus disease (COVID-19). Although applied to stabilize respiratory status, in awake patients, the application of prone position may reduce comfort with a consequent increase in the workload imposed on respiratory muscles. Thus, we primarily ascertained the effect of awake prone position on diaphragmatic thickening fraction, assessed through ultrasound, in COVID-19 patients undergoing NIV. Methods We enrolled all COVID-19 adult critically ill patients, admitted to intensive care unit (ICU) for hypoxemic ARF and undergoing NIV, deserving of awake prone positioning as a rescue therapy. Exclusion criteria were pregnancy and any contraindication to awake prone position and NIV. On ICU admission, after NIV onset, in supine position, and at 1 h following awake prone position application, diaphragmatic thickening fraction was obtained on the right side. Across all the study phases, NIV was maintained with the same setting present at study entry. Vital signs were monitored throughout the entire study period. Comfort was assessed through numerical rating scale (0 the worst comfort and 10 the highest comfort level). Data were presented in median and 25th–75th percentile range. Results From February to May 2021, 20 patients were enrolled and finally analyzed. Despite peripheral oxygen saturation improvement [96 (94–97)% supine vs 98 (96–99)% prone, p = 0.008], turning to prone position induced a worsening in comfort score from 7.0 (6.0–8.0) to 6.0 (5.0–7.0) (p = 0.012) and an increase in diaphragmatic thickening fraction from 33.3 (25.7–40.5)% to 41.5 (29.8–50.0)% (p = 0.025). Conclusions In our COVID-19 patients assisted by NIV in ICU, the application of awake prone position improved the oxygenation at the expense of a greater diaphragmatic thickening fraction compared to supine position. Trial registration ClinicalTrials.gov, number NCT04904731. Registered on 05/25/2021, retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04904731.

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Lung ultrasound can predict response to the prone position in awake non-intubated patients with COVID‑19 associated acute respiratory distress syndrome

Cited by 25 publications

References 6 publications

Prone position in COVID 19-associated acute respiratory failure

Prone position in COVID 19-associated acute respiratory failure

Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO)

Effect of awake prone position on diaphragmatic thickening fraction in patients assisted by noninvasive ventilation for hypoxemic acute respiratory failure related to novel coronavirus disease

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