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

J Crit Care

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:

Published: April 2016

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.

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http://dx.doi.org/10.1016/j.jcrc.2015.12.015DOI Listing

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