TY - JOUR
T1 - Lung ultrasound to predict gas-exchange response to prone positioning in COVID-19 patients
T2 - A prospective study in pilot and confirmation cohorts
AU - Heldeweg, M L A
AU - Mousa, A
AU - van Ekeren, J
AU - Lieveld, A W E
AU - Walburgh-Schmidt, R S
AU - Smit, J M
AU - Haaksma, M E
AU - de Grooth, H J
AU - Heunks, L M A
AU - Tuinman, P R
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2023/2
Y1 - 2023/2
N2 - PURPOSE: To examine whether lung ultrasound prior to prone positioning can predict the resulting gas-exchange response.MATERIALS AND METHODS: This is a prospective observational study on critically-ill COVID-19 patients with a pilot and confirmation cohort. Lung ultrasound examinations were performed before prone positioning and gas-exchange parameters were recorded before and after position change.RESULTS: A total of 79 patients, 36 in the pilot cohort and 43 in the confirmation cohort, were included. In the pilot cohort, a moderate correlation between pre-turn lung ultrasound score index (LUSI) and change in PaO2/FiO2 after prone positioning was found. These findings were corroborated and extended upon in the confirmation cohort. The confirmation cohort found that anterior LUSI had the strongest correlation with follow-up time-points 1, 6, 12, and 24 h after prone positioning, with strength of correlation gradually increasing up to 24 h. In a multivariate model anterior aeration loss (odds ratio 0.035; 95%CI 0.003-0.319 for anterior LUSI >50%) and higher pre-turn PaCO2 (odds ratio 0.479 95% CI 0.235-0.979) were negatively predictive of a PaO2/FiO2 increase ≥20 mmHg.CONCLUSIONS: Anterior LUSI, in addition to other clinical parameters, may be used to aid COVID-19 respiratory strategy and a clinician's decision to prone.
AB - PURPOSE: To examine whether lung ultrasound prior to prone positioning can predict the resulting gas-exchange response.MATERIALS AND METHODS: This is a prospective observational study on critically-ill COVID-19 patients with a pilot and confirmation cohort. Lung ultrasound examinations were performed before prone positioning and gas-exchange parameters were recorded before and after position change.RESULTS: A total of 79 patients, 36 in the pilot cohort and 43 in the confirmation cohort, were included. In the pilot cohort, a moderate correlation between pre-turn lung ultrasound score index (LUSI) and change in PaO2/FiO2 after prone positioning was found. These findings were corroborated and extended upon in the confirmation cohort. The confirmation cohort found that anterior LUSI had the strongest correlation with follow-up time-points 1, 6, 12, and 24 h after prone positioning, with strength of correlation gradually increasing up to 24 h. In a multivariate model anterior aeration loss (odds ratio 0.035; 95%CI 0.003-0.319 for anterior LUSI >50%) and higher pre-turn PaCO2 (odds ratio 0.479 95% CI 0.235-0.979) were negatively predictive of a PaO2/FiO2 increase ≥20 mmHg.CONCLUSIONS: Anterior LUSI, in addition to other clinical parameters, may be used to aid COVID-19 respiratory strategy and a clinician's decision to prone.
KW - COVID-19
KW - Humans
KW - Lung/diagnostic imaging
KW - Positive-Pressure Respiration/methods
KW - Prone Position/physiology
KW - Prospective Studies
KW - Pulmonary Gas Exchange/physiology
KW - Respiration, Artificial
KW - Respiratory Distress Syndrome
U2 - 10.1016/j.jcrc.2022.154173
DO - 10.1016/j.jcrc.2022.154173
M3 - Article
C2 - 36265246
SN - 0883-9441
VL - 73
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 154173
ER -