Lung ultrasound response to awake prone positioning predicts the need for intubation in patients with COVID-19 induced acute hypoxemic respiratory failure: an observational study

Autor: Miguel Ibarra-Estrada, María J. Gamero-Rodríguez, Marina García-de-Acilu, Oriol Roca, Laura Sandoval-Plascencia, Guadalupe Aguirre-Avalos, Roxana García-Salcido, Sara A. Aguirre-Díaz, David L. Vines, Sara Mirza, Ramandeep Kaur, Tyler Weiss, Claude Guerin, Jie Li
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Critical Care, Vol 26, Iss 1, Pp 1-12 (2022)
Druh dokumentu: article
ISSN: 1364-8535
DOI: 10.1186/s13054-022-04064-3
Popis: Abstract Background Awake prone positioning (APP) reduces the intubation rate in COVID-19 patients treated by high-flow nasal cannula (HFNC). However, the lung aeration response to APP has not been addressed. We aimed to explore the lung aeration response to APP by lung ultrasound (LUS). Methods This two-center, prospective, observational study enrolled patients with COVID-19-induced acute hypoxemic respiratory failure treated by HFNC and APP. LUS score was recorded 5–10 min before, 1 h after APP, and 5–10 min after supine in the first APP session within the first three days. The primary outcome was LUS score changes in the first three days. Secondary outcomes included changes in SpO2/FiO2 ratio, respiratory rate and ROX index (SpO2/FiO2/respiratory rate) related to APP, and the rate of treatment success (patients who avoided intubation). Results Seventy-one patients were enrolled. LUS score decreased from 20 (interquartile range [IQR] 19–24) to 19 (18–21) (p 1 after the first APP session was associated with decreased risk for intubation (Relative risk 0.25 [0.09–0.69]). APP daily duration was correlated with LUS score reduction in patients with treatment success, especially in dorsal lung zones (r = − 0.76; p
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