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Journal of critical care · Feb 2023
Observational StudyLung ultrasound to predict gas-exchange response to prone positioning in COVID-19 patients: A prospective study in pilot and confirmation cohorts.
- M L A Heldeweg, A Mousa, J van Ekeren, A W E Lieveld, R S Walburgh-Schmidt, J M Smit, M E Haaksma, H J de Grooth, HeunksL M ALMADepartment of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands. Electronic address: l.heunks@erasmusmc.nl., and P R Tuinman.
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Amsterdam Leiden IC Focused Echography (ALIFE, http://www.alifeofpocus.com), the Netherlands. Electronic address: m.heldeweg@amsterdamumc.nl.
- J Crit Care. 2023 Feb 1; 73: 154173154173.
PurposeTo examine whether lung ultrasound prior to prone positioning can predict the resulting gas-exchange response.Materials And MethodsThis 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.ResultsA 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.ConclusionsAnterior LUSI, in addition to other clinical parameters, may be used to aid COVID-19 respiratory strategy and a clinician's decision to prone.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.
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