Gwenaël Prat1, Solène Guinard2, Nicolas Bizien3, Emmanuel Nowak4, Jean-Marie Tonnelier5, Zarrin Alavi6, Anne Renault7, Jean-Michel Boles8, Erwan L'Her9. 1. Réanimation Médicale, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. Electronic address: gwenael.prat@chu-brest.fr. 2. Réanimation Médicale, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. Electronic address: soleneguinard@yahoo.fr. 3. Réanimation Médicale, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. Electronic address: biziennico@gmail.com. 4. UBO, CIC INSERM 1412, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. Electronic address: emmanuel.nowak@chu-brest.fr. 5. Réanimation Médicale, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. Electronic address: jean-marie.tonnelier@chu-brest.fr. 6. UBO, CIC INSERM 1412, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. Electronic address: zarrin.alavi@chu-brest.fr. 7. Réanimation Médicale, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. Electronic address: anne.renault@chu-brest.fr. 8. Réanimation Médicale, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. Electronic address: jean-michel.boles@chu-brest.fr. 9. Réanimation Médicale, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France; LATIM INSERM UMR1101, CHRU de Brest, Université de Bretagne Occidentale, 29200 Brest, France. Electronic address: erwan.lher@chu-brest.fr.
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 PaO2/FIO2 ratio improvement.
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 ARDSpatients 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 ARDSpatients. A normal L-US pattern of both anterobasal lung regions in supine position may predict a significant PaO2/FIO2 ratio improvement.
Authors: P H Mayo; R Copetti; D Feller-Kopman; G Mathis; E Maury; S Mongodi; F Mojoli; G Volpicelli; M Zanobetti Journal: Intensive Care Med Date: 2019-08-15 Impact factor: 17.440
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