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01-10-2016 | Original

Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS

Authors: Malik Haddam, Laurent Zieleskiewicz, Sebastien Perbet, Alice Baldovini, Christophe Guervilly, Charlotte Arbelot, Alexandre Noel, Coralie Vigne, Emmanuelle Hammad, François Antonini, Samuel Lehingue, Eric Peytel, Qin Lu, Belaid Bouhemad, Jean-Louis Golmard, Olivier Langeron, Claude Martin, Laurent Muller, Jean-Jacques Rouby, Jean-Michel Constantin, Laurent Papazian, Marc Leone, CAR’Echo Collaborative Network, AzuRea Collaborative Network

Published in: Intensive Care Medicine | Issue 10/2016

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.

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Title: Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS
Authors: Malik Haddam
Laurent Zieleskiewicz
Sebastien Perbet
Alice Baldovini
Christophe Guervilly
Charlotte Arbelot
Alexandre Noel
Coralie Vigne
Emmanuelle Hammad
François Antonini
Samuel Lehingue
Eric Peytel
Qin Lu
Belaid Bouhemad
Jean-Louis Golmard
Olivier Langeron
Claude Martin
Laurent Muller
Jean-Jacques Rouby
Jean-Michel Constantin
Laurent Papazian
Marc Leone
CAR’Echo Collaborative Network
AzuRea Collaborative Network
Publication date: 01-10-2016
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 10/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4411-7

At a glance: The STEP trials

Springer Medicine

Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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