Use of Lung Ultrasound for Assessment of Lung Recruitment Maneuvers in Patients with ARDS

Abstract

BACKGROUND: Positive pressure mechanical ventilation is a non-physiological intervention that saves lives but is not free of important side effects. It invariably results in different degrees of collapse of small airways. Recruitment maneuver (RM) aims to resolve lung collapse by a brief and controlled increment in airway pressure while positive end-expiratory pressure (PEEP) afterward keeps the lungs open. Therefore, ideally RM and PEEP selection must be individualized and this can only be done when guided by specific monitoring tools since lung’s opening and closing pressures vary among patients with different lung conditions. AIM: The aim of this study was to explore the clinical value of ultrasonic monitoring in the assessment of pulmonary recruitment and the best PEEP. PATIENTS AND METHODS: This study was conducted on 120 patients, 30 were excluded as in whom lung collapse cannot be confirmed then the rest were 90 patients from whom another 25 patients excluded as they were hemodynamically unstable the rest 65 patients were divided into two groups: Group A: Included 50 mechanically ventilated patients with ARDS, underwent lung recruitment using lung ultrasound and Group B: Included 15 mechanically ventilated patients with ARDS, underwent lung recruitment using oxygenation index. This prospective study was held at many critical care departments around Egypt. RESULTS: We noticed that lung recruitment in both groups significantly increased Pao2/Fio2 ratio immediately after recruitment compared with basal state and also significantly increase dynamic compliance compared with basal state. The increase in PF ratio immediately was significantly more in ultrasound group than in oxygenation group. Furthermore, we noticed that that P/F ratio 12 h after recruitment decreased compared with P/F ratio immediately after recruitment but significantly increased compared with basal state before recruitment and also we found that the increase in P/F ratio 12 h after recruitment was more significantly in lung ultrasound group than in oxygenation group. Furthermore, we noticed that lung recruitment (both lung ultrasound and oxygenation group) significantly increase RV function using TAPSE compared with basal state. Both opening pressure and optimal PEEP were significantly higher in lung ultrasound group than in oxygenation group. In our study, opening pressure was 37.28 ± 1.25 in lung ultrasound group and was 36.67±0.98 in oxygenation group and optimal PEEP was 14.64 ± 1.08 in lung ultrasound group and was 13.13 ± 0.74 in oxygenation group. CONCLUSION: Lung US is an effective mean of evaluating and guiding alveolar recruitment in ARDS. Compared with the maximal oxygenation–guided method, the protocol for reaeration in US-guided lung recruitment achieved a higher opening pressure, resulted in greater improvements in lung aeration, and substantially reduced lung heterogeneity in ARDS.

Setting the optimal positive end-expiratory pressure: a narrative review

“…Lung ultrasound has been proposed to be a more practical method for imaging the lung and has been shown to be effective in evaluating and guiding alveolar recruitment ( 54 ). An ultrasound re-aeration score has been published and was shown to be correlated with increases in oxygenation and increases in lung recruitment ( 55 ).…”

Using lung ultrasound to guide PEEP determination in mechanically ventilated patients with acute respiratory distress syndrome

“…Or-as demonstrated by several authors in the next section-to guide PEEP determination in patients with ARDS. [13][14][15][16][17] term "hepatization") depending on the extent of aeration present. The observation that the sonographic appearance of the lung changes depending on the level of aeration present is the basis for the ultrasound reaeration score, the lung ultrasound score, and the methods that use these scores to determine optimal PEEP levels in patients with ARDS.…”

“…[6][7][8][9][10][11][12] Transthoracic lung ultrasonography, also known as lung ultrasound, has recently been proposed as a tool to guide PEEP determination. [13][14][15][16][17] Lung ultrasound is a non-invasive imaging method that can be used to detect lung abnormalities present in ARDS (e.g., pulmonary consolidations and edema), distinguish between focal and non-focal ARDS morphologies, and quantify the extent of lung injury in ARDS, all with accuracies comparable to the current gold standard of chest imaging, computed tomography (CT). [18][19][20] Lung ultrasound can also be used to assess changes in lung aeration brought on by adjustments in PEEP, although its ability to guide clinical decisions regarding PEEP setting is disputed.…”

“…[18][19][20] Lung ultrasound can also be used to assess changes in lung aeration brought on by adjustments in PEEP, although its ability to guide clinical decisions regarding PEEP setting is disputed. 16,[20][21][22] This article reviews the use…”

“…The Southwest Respiratory and Critical Care Chronicles 2023;11 (47): [10][11][12][13][14][15][16][17][18][19][20] of lung ultrasound in finding optimal PEEP values and evaluates its usefulness in ARDS management. bAckground Historically, the lungs were considered poor subjects for ultrasonographic examination because ultrasound does not penetrate healthy lung tissue well.…”