Malik Haddam1, Laurent Zieleskiewicz1, Sebastien Perbet2, Alice Baldovini1, Christophe Guervilly3, Charlotte Arbelot4, Alexandre Noel5, Coralie Vigne1, Emmanuelle Hammad1, François Antonini1, Samuel Lehingue3, Eric Peytel5, Qin Lu4, Belaid Bouhemad6, Jean-Louis Golmard4, Olivier Langeron4, Claude Martin1, Laurent Muller7, Jean-Jacques Rouby4, Jean-Michel Constantin2, Laurent Papazian3, Marc Leone8. 1. Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Chemin des Bourrely, 13015, Marseille, France. 2. Département de Médecine Périopératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France. 3. Service de réanimation DRIS, Hôpital Nord, Aix Marseille Université, Marseille, France. 4. Réanimation polyvalente, département d'anesthésie et de réanimation, Hôpital Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris (APHP), Université Pierre et Marie Curie Paris 6 (UPMC), Paris, France. 5. Service d'anesthésie et réanimation, Hôpital d'instruction des armées, Laveran, Marseille, France. 6. Centre Hospitalier Universitaire de Dijon, 36659, Service Anesthésie Réanimation, Dijon, Bourgogne, France. 7. Service des réanimations, pôle anesthésie réanimation douleur urgence, CHU Nîmes, Nîmes, France. 8. Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Chemin des Bourrely, 13015, Marseille, France. marc.leone@ap-hm.fr.
Abstract
PURPOSE: Prone position (PP) improves oxygenation and outcome of acute respiratory distress syndrome (ARDS) patients with a PaO2/FiO2 ratio <150 mmHg. Regional changes in lung aeration can be assessed by lung ultrasound (LUS). Our aim was to predict the magnitude of oxygenation response after PP using bedside LUS. METHODS: We conducted a prospective multicenter study that included adult patients with severe and moderate ARDS. LUS data were collected at four time points: 1 h before (baseline) and 1 h after turning the patient to PP, 1 h before and 1 h after turning the patient back to the supine position. Regional lung aeration changes and ultrasound reaeration scores were assessed at each time. Overdistension was not assessed. RESULTS: Fifty-one patients were included. Oxygenation response after PP was not correlated with a specific LUS pattern. The patients with focal and non-focal ARDS showed no difference in global reaeration score. With regard to the entire PP session, the patients with non-focal ARDS had an improved aeration gain in the anterior areas. Oxygenation response was not associated with aeration changes. No difference in PaCO2 change was found according to oxygenation response or lung morphology. CONCLUSIONS: In ARDS patients with a PaO2/FiO2 ratio ≤150 mmHg, bedside LUS cannot predict oxygenation response after the first PP session. At the bedside, LUS enables monitoring of aeration changes during PP.
PURPOSE: Prone position (PP) improves oxygenation and outcome of acute respiratory distress syndrome (ARDS) patients with a PaO2/FiO2 ratio <150 mmHg. Regional changes in lung aeration can be assessed by lung ultrasound (LUS). Our aim was to predict the magnitude of oxygenation response after PP using bedside LUS. METHODS: We conducted a prospective multicenter study that included adult patients with severe and moderate ARDS. LUS data were collected at four time points: 1 h before (baseline) and 1 h after turning the patient to PP, 1 h before and 1 h after turning the patient back to the supine position. Regional lung aeration changes and ultrasound reaeration scores were assessed at each time. Overdistension was not assessed. RESULTS: Fifty-one patients were included. Oxygenation response after PP was not correlated with a specific LUS pattern. The patients with focal and non-focal ARDS showed no difference in global reaeration score. With regard to the entire PP session, the patients with non-focal ARDS had an improved aeration gain in the anterior areas. Oxygenation response was not associated with aeration changes. No difference in PaCO2 change was found according to oxygenation response or lung morphology. CONCLUSIONS: In ARDS patients with a PaO2/FiO2 ratio ≤150 mmHg, bedside LUS cannot predict oxygenation response after the first PP session. At the bedside, LUS enables monitoring of aeration changes during PP.
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