• 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, and AzuRea Collaborative Network.
• Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Chemin des Bourrely, 13015, Marseille, France.
• Intensive Care Med. 2016 Oct 1; 42 (10): 1546-1556.

PurposeProne 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.MethodsWe 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.ResultsFifty-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.ConclusionsIn 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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