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

• Published in: Journal of critical care 2016-04, Vol.32, p.36-41
• Main Authors: Prat, Gwenaël, Guinard, Solène, Bizien, Nicolas, Nowak, Emmanuel, Tonnelier, Jean-Marie, Alavi, Zarrin, Renault, Anne, Boles, Jean-Michel, L’Her, Erwan, MD, PhD
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Adult; Critical Care; Edema; Female; Hemothorax - diagnostic imaging; Hemothorax - etiology; Hemothorax - therapy; Human health and pathology; Humans; Life Sciences; Lung - diagnostic imaging; Lung - pathology; Lung ultrasonography; Male; Middle Aged; Mortality; Physiology; Positive-Pressure Respiration - methods; Practice Guidelines as Topic; Predictive Value of Tests; Prone Position; Prone positioning; Prospective Studies; Pulmonary Gas Exchange; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - complications; Respiratory Distress Syndrome, Adult - diagnostic imaging; Respiratory Distress Syndrome, Adult - therapy; Ultrasonic imaging; Ventilation
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2015.12.015

Abstract Purpose 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 Pa o2 /F io2 ratio improvement.