Lung ultrasound to evaluate aeration changes in response to recruitment maneuver and prone positioning in intubated patients with COVID-19 pneumonia: preliminary study

Abstract

Background This single-center preliminary prospective observational study used bedside ultrasound to assess the lung aeration modifications induced by recruitment maneuver and pronation in intubated patients with acute respiratory disease syndrome (ARDS) related to coronavirus 2019 disease (COVID-19). All adult intubated COVID-19 patients suitable for pronation were screened. After enrollment, patients underwent 1 h in a volume-controlled mode in supine position (baseline) followed by a 35-cmH2O-recruitment maneuver of 2 min (recruitment). Final step involved volume-controlled mode in prone position set as at baseline (pronation). At the end of the first two steps and 1 h after pronation, a lung ultrasound was performed, and global and regional lung ultrasound score (LUS) were analyzed. Data sets are presented as a median and 25th–75th percentile. Results From January to May 2022, 20 patients were included and analyzed. Global LUS reduced from 26.5 (23.5–30.0) at baseline to 21.5 (18.0–23.3) and 23.0 (21.0–26.3) at recruitment (p < 0.001) and pronation (p = 0.004). In the anterior lung regions, the regional LUS were 1.8 (1.1–2.0) following recruitment and 2.0 (1.6–2.2) in the supine (p = 0.008) and 2.0 (1.8–2.3) in prone position (p = 0.023). Regional LUS diminished from 2.3 (2.0–2.5) in supine to 2.0 (1.8–2.0) with recruitment in the lateral lung zones (p = 0.036). Finally, in the posterior lung units, regional LUS improved from 2.5 (2.3–2.8) in supine to 2.3 (1.8–2.5) through recruitment (p = 0.003) and 1.8 (1.3–2.2) with pronation (p < 0.0001). Conclusions In our investigation, recruitment maneuver and prone positioning demonstrated an enhancement in lung aeration when compared to supine position, as assessed by bedside lung ultrasound. Trial registration: www.clinicaltrials.gov, Number NCT05209477, prospectively registered and released on 01/26/2022.

Intraoperative lung protection: strategies and their impact on outcomes

“…During surgery, real-time lung ultrasound proves effective in monitoring atelectasis, alveolar consolidation, and diaphragmatic issues [57]. Through its capacity to evaluate PEEP-driven lung recruitment, it offers valuable insights into discerning patients who could profit from elevated PEEP levels or recruitment techniques [72]. Nevertheless, it is essential to emphasize that the exact impact of ultrasound on patient outcomes has yet to be definitively established.…”

Monitoring lung recruitment

“…To address this limitation, the authors suggest better characterizing severe and complete aeration loss by considering the extent of pleural line involvement (>50%) and the predominance of the aeration pattern [42,43]. Keeping this in mind, Cammarota et al [44 ▪▪ ] evaluated the effects of recruiting maneuvers and prone position on lung aeration in intubated patients with COVID-19-related ARDS. Global and regional LUS changed with the recruiting maneuver and pronation, potentially characterizing nonaerated lung regions into consolidation or atelectasis in response to the recruiting maneuver and pronation by ultrasound [44 ▪▪ ].…”

“…Keeping this in mind, Cammarota et al [44 ▪▪ ] evaluated the effects of recruiting maneuvers and prone position on lung aeration in intubated patients with COVID-19-related ARDS. Global and regional LUS changed with the recruiting maneuver and pronation, potentially characterizing nonaerated lung regions into consolidation or atelectasis in response to the recruiting maneuver and pronation by ultrasound [44 ▪▪ ]. In COVID-19-related ARDS, lung ultrasound was useful for predicting the oxygenation response following pronation [45 ▪ ].…”

A Comprehensive Review of Prone Ventilation in the Intensive Care Unit: Challenges and Solutions

“…Recognizing and addressing the psychological challenges faced by both patients and caregivers during prone ventilation is essential for comprehensive care. Implementing psychosocial support programs within the ICU setting can include regular communication with patients about their experiences, addressing fears and anxieties, and involving mental health professionals when needed [ 28 ]. For caregivers, establishing a supportive environment that encourages open communication with the healthcare team is crucial.…”