Lung ultrasound to predict gas-exchange response to prone positioning in COVID-19 patients : A prospective study in pilot and confirmation cohorts. / Heldeweg, M. L. A.; Mousa, A.; van Ekeren, J. et al.
In: Journal of critical care, Vol. 73, 154173, 01.02.2023.Research output: Contribution to journal › Article › Academic › peer-review
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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 - Funding Information: Not applicable. Publisher Copyright: © 2022 The Authors
PY - 2023/2/1
Y1 - 2023/2/1
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 - Lung
KW - Prone position
KW - Respiratory distress syndrome
KW - Ultrasonography
UR - http://www.scopus.com/inward/record.url?scp=85140083050&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2022.154173
DO - 10.1016/j.jcrc.2022.154173
M3 - Article
C2 - 36265246
VL - 73
JO - Journal of critical care
JF - Journal of critical care
SN - 0883-9441
M1 - 154173
ER -
ID: 26556245