Lung ultrasound to predict gas-exchange response to prone positioning in COVID-19 patients: A prospective study in pilot and confirmation cohorts

To examine whether lung ultrasound prior to prone positioning can predict the resulting gas-exchange response. 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...

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Bibliographic Details
Published in:	Journal of critical care Vol. 73; p. 154173
Main Authors:	Heldeweg, M.L.A., Mousa, A., van Ekeren, J., Lieveld, A.W.E., Walburgh-Schmidt, R.S., Smit, J.M., Haaksma, M.E., de Grooth, H.J., Heunks, L.M.A., Tuinman, P.R.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-02-2023 Elsevier Limited The Author(s). Published by Elsevier Inc
Subjects:	Coronaviruses COVID-19 Critical care Humans Lung Lung - diagnostic imaging Patient positioning Positive-Pressure Respiration - methods Pressure ulcers Prone position Prone Position - physiology Prospective Studies Pulmonary Gas Exchange - physiology Respiration, Artificial Respiratory Distress Syndrome Statistical analysis Ultrasonic imaging Ultrasonography Variables Ventilators COVID-19 Prone position Respiratory distress syndrome Lung Ultrasonography
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Summary:	To examine whether lung ultrasound prior to prone positioning can predict the resulting gas-exchange response. 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. 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. Anterior LUSI, in addition to other clinical parameters, may be used to aid COVID-19 respiratory strategy and a clinician's decision to prone. •Prone positioning may confer survival benefits in critically-ill COVID-19 patients•Lung ultrasound prior to prone positioning correlates to gas-exchange response•A high anterior lung ultrasound score predicts poor gas-exchange response•Lung ultrasound may aid decisions on respiratory strategy in COVID-19 patients
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0883-9441 1557-8615
DOI:	10.1016/j.jcrc.2022.154173