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Observational Study
. 2023 Feb:73:154173.
doi: 10.1016/j.jcrc.2022.154173. Epub 2022 Oct 18.

Lung 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  1 , A Mousa  2 , J van Ekeren  3 , A W E Lieveld  4 , R S Walburgh-Schmidt  5 , J M Smit  6 , M E Haaksma  7 , H J de Grooth  8 , L M A Heunks  9 , P R Tuinman  10
Affiliations
Observational Study

Lung 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 et al. J Crit Care. 2023 Feb.

Abstract

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.

Keywords: COVID-19; Lung; Prone position; Respiratory distress syndrome; Ultrasonography.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Fig. 1
Fig. 1
Correlation heat map of LUSI and Δ gas-exchange across prone positioning. Numbers are Spearman’s correlation coefficient. Heat range is from −0.5 to 0.5.
Fig. 2
Fig. 2
Correlation heat map of LUSI parameters and gas-exchange parameters across follow-up time-points 1, 6, 12, and 24 hours. Numbers are Spearman’s correlation coefficient. Heat range is from −0.5 to 0.5.
Fig. 3
Fig. 3
Progression of Δ PaO2/FiO2 across all time-points when comparing anterior LUSI >50 and ≤50%. The asterix (*) refers to a significant difference between categories of anterior LUSI. Shaded area is 95% confidence interval. A graph with absolute PaO2/FiO2 is found in appendix I.
See this image and copyright information in PMC

Comment in

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