Can lung ultrasonography predict prone positioning response in acute respiratory distress syndrome patients?

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• 作者：Gwenaë ; l Prat^a ; ^{gwenael.prat@chu-brest.fr" class="auth_mail" title="E-mail the corresponding author} ; Solè ; ne Guinard^a ; ^{soleneguinard@yahoo.fr" class="auth_mail" title="E-mail the corresponding author} ; Nicolas Bizien^a ; ^{biziennico@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Emmanuel Nowak^b ; ^{emmanuel.nowak@chu-brest.fr" class="auth_mail" title="E-mail the corresponding author} ; Jean-Marie Tonnelier^a ; ^{jean-marie.tonnelier@chu-brest.fr" class="auth_mail" title="E-mail the corresponding author} ; Zarrin Alavi^b ; ^{zarrin.alavi@chu-brest.fr" class="auth_mail" title="E-mail the corresponding author} ; Anne Renault^a ; ^{anne.renault@chu-brest.fr" class="auth_mail" title="E-mail the corresponding author} ; Jean-Michel Boles^a ; ^{jean-michel.boles@chu-brest.fr" class="auth_mail" title="E-mail the corresponding author} ; Erwan L&rsquo ; Her ; MD ; PhD^a ; ^c ; ^{erwan.lher@chu-brest.fr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ARDS ; acute respiratory distress syndrome ; CT scan ; computed tomographic scan ; ICU ; intensive care unit ; LU ; lung ultrasonography ; PEEP ; positive end-expiratory pressure ; P/F ; Pao2/Fio2 ratio ; PP ; prone positioning ; S/F ratio ; Sao2/Fio2 ratio
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：32
• 期：Complete
• 页码：36-41
• 全文大小：556 K

文摘

The purpose was to assess whether lung ultrasonography (L-US) is a useful tool in prediction of prone positioning (PP) oxygenation response in patients with acute respiratory distress syndrome (ARDS).

Methods

In a prospective study, 19 ARDS patients were included for assessment of PP oxygenation response. The latter was assessed for at least 12 hours 6 different ultrasonography windows were performed on each hemithorax before prone (H0, H2, H12 before return to supine and at H14 (2 hours after return to supine). Patients were classified into 2 groups (responders / non responders) according their oxygenation response to PP. Ultrasonography videos were blindly evaluated by 3 expert clinicians to classify lung regions as “normal”, “moderate loss of aeration,” “severe loss of aeration,” or “lung consolidation.” Oxygenation parameters were collected at H0, H2, and H14.

Results

Association of each lung region aspect to PP oxygenation response was compared between the 2 groups. The normal aspect of the anterobasal regions was significantly associated with the oxygenation response (P = .0436), with a positive predictive value equal to or near 100%.

Discussion

Our results demonstrated that a simple and short L-US examination could be a useful tool in prediction of PP oxygenation response in ARDS patients. A normal L-US pattern of both anterobasal lung regions in supine position may predict a significant Pao₂/Fio₂ ratio improvement.