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.
Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands.
J Crit Care. 2023 Feb;73:154173. doi: 10.1016/j.jcrc.2022.154173. Epub 2022 Oct 18.
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 PaCO (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.
探讨俯卧位前肺超声检查能否预测其对气体交换的影响。
这是一项针对 COVID-19 危重症患者的前瞻性观察研究，包含了一个试点和确认队列。在俯卧位前进行肺超声检查，并记录体位改变前后的气体交换参数。
共纳入 79 例患者，其中试点队列 36 例，确认队列 43 例。在试点队列中，发现俯卧位前肺超声评分指数（LUSI）与俯卧位后 PaO2/FiO2 变化之间存在中度相关性。这些发现在确认队列中得到了证实和扩展。确认队列发现，前侧 LUSI 与俯卧位后 1、6、12 和 24 小时的随访时间点相关性最强，相关性强度逐渐增加至 24 小时。在多变量模型中，前侧充气损失（比值比 0.035；95%CI 0.003-0.319，前 LUSI >50%）和较高的俯卧位前 PaCO2（比值比 0.479；95%CI 0.235-0.979）与 PaO2/FiO2 增加≥20mmHg 呈负相关。
除其他临床参数外，前侧 LUSI 可用于辅助 COVID-19 呼吸策略和临床医生对俯卧位的决策。
