Positive end-expiratory pressure lung recruitment: comparison between lower inflection point and ultrasound assessment

Rode, Bojan; Vučić, Marinko; Širanović, Mladen; Horvat, A.; Krolo, Helena; Kelečić, Mijo; Gopčević, Aleksandar

doi:10.1007/s00508-012-0303-1

Cited by 21 publications

(22 citation statements)

References 28 publications

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“…Among lung US studies in ARDS, correlations of lung US aeration patterns with the pressure‐volume curve as well as CT have been demonstrated . Dependent lung regions seem to be poorly recruitable; however, this process probably depends on the strategy aimed at “opening” these poorly aerated tissues, as well as lung morphologic characteristics, although the last point is controversial . Of note, positive lung US imaging changes may not have a linear correlation with the improvement in oxygenation, as shown by Haddam et al and Wang et al as well as in a study that interestingly showed worsening aeration measured by lung US after fluid loading in septic patients with ARDS, without an alteration in oxygenation .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In 17 patients with ARDS, Rode et al found a significant correlation between reaeration of subpleural consolidations using transthoracic lung US and the lower inflection point of the pressure‐volume curve for PEEP titration ( r = 0.839; P < .05). The PEEP required for reaeration of subpleural consolidation with transthoracic lung US always exceeded the pressures of the lower inflection point.…”

Section: Literature Regarding Lung Us For Monitoring Aeration In Ardsmentioning

confidence: 99%

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Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review

Bello

Blanco

2018

J of Ultrasound Medicine

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Acute respiratory distress syndrome (ARDS) constitutes a high burden for intensive care units. Although several methods are proposed to monitor aeration in ARDS, availability, costs, simplicity, and hazards (eg, ionizing radiation) limit the use of many of them at patients' bedsides. Given the widespread use of lung ultrasonography (US) in intensive care units, research is growing regarding its use to monitor aeration in patients with ARDS. We reviewed the actual role of lung US in ARDS and its potential impact in practice. Lung US can be readily used for assessing aeration, although, as a main limitation, a normal lung cannot be distinguished from hyperinflation. Additionally, an improvement in aeration by lung US does not always correlate with an increase in oxygenation. Lung US can be considered the main imaging method for monitoring aeration in ARDS, but in view of its limitations, it should not be used in isolation. Further studies are needed to validate lung US in large ARDS populations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Literature Regarding Lung Us For Monitoring Aeration In Ardsmentioning

confidence: 99%

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Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review

Bello

Blanco

2018

J of Ultrasound Medicine

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“…LUS score-quantified aeration changes observed in patients with ventilator-associated pneumonia upon initiation of antimicrobial therapy showed a tight correlation with CT measurements of lung aeration [8]. When compared with the pressure-volume curve method of assessing PEEP-induced lung recruitment in acute lung injury (ALI)/ARDS, the same score was accurate in detecting significant increases in lung aeration [16, 17]. During a successful spontaneous breathing trial, aeration changes measured by LUS scores may accurately predict postextubation distress [18].…”

Section: Discussionmentioning

confidence: 99%

Lung ultrasound can be used to predict the potential of prone positioning and assess prognosis in patients with acute respiratory distress syndrome

et al. 2016

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BackgroundIt is very important to assess the effectiveness of prone positioning (PP) in patients with severe acute respiratory distress syndrome (ARDS). However, it is difficult to identify patients who may benefit from PP. The purpose of this study was to investigate whether prone positioning potential (PPP) can be predicted by lung ultrasound in patients with ARDS.MethodsIn this prospective study, 45 patients with ARDS were included for the assessment of PPP. A PP lung ultrasound examination (PLUE) protocol was performed in the dorsal regions of the lung in 16 areas at H0, H3, and H6 (0, 3, and 6 h after PP). The ultrasonography videos were blindly evaluated by two expert clinicians to classify the lung regions as normal pattern (N), moderate loss of lung aeration (B1), severe loss of lung aeration (B2), and consolidation (C). The aeration scores were collected at H0, H3, and H6. According to the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (P/F ratio) at 7 days, patients were classified into PPP-positive (P/F ratio >300) and PPP-negative groups; also, the patients were classified into survival and nonsurvival groups according to 28-day mortality.ResultsAeration scores was compared at H0, H3, and H6. The scores were significantly reduced between H3 and H0, but there was no difference between H3 and H6. The aeration score variation (ASV) of the PPP-positive group between H3 and H0 was significantly higher than that in the PPP-negative group, and the sensitivity and specificity of ASV ≥5.5 for the PPP-positive group were 73.9% and 86.4%, respectively. The area under the receiver operating characteristic curve (AUROC) was 0.852 for the ASV. The ASV between H3 and H0 in the survival group was significantly higher than in the nonsurvival group. The sensitivity and specificity of ASV ≥7 for survival were 51.5% and 75%, respectively. The AUROC was 0.702 for the ASV.ConclusionsThe PLUE protocol can be used to predict PPP and assess prognosis in patients with ARDS.

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“…A subsequent study showed that lung reaeration can be estimated accurately with bedside lung US. 7 Recently, Rode et al 8 proposed that lung US could guide lung recruitment by using PEEP, with improvement in lung consolidation as a sign of improved alveolar ventilation. Presently, there is no systematic USguided lung recruitment protocol available for clinical use.…”

mentioning

confidence: 99%

Use of Lung Ultrasound to Assess the Efficacy of an Alveolar Recruitment Maneuver in Rabbits With Acute Respiratory Distress Syndrome

Liu

Long

et al. 2015

J of Ultrasound Medicine

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Objectives To investigate the application of lung ultrasound (US) in the evaluation and implementation of alveolar recruitment maneuvers in acute respiratory distress syndrome (ARDS). Methods Twelve rabbits with saline lavage–induced lung injury were randomly divided into 2 groups: one with alveolar recruitment guided by lung US and the other with alveolar recruitment guided by maximal oxygenation. Recruitment maneuvers were applied according to a stepwise incremental positive end‐expiratory pressure method in both groups. In the oxygenation group, a sum of the partial pressures of oxygen and carbon dioxide exceeding 400 mm Hg was used to define adequate recruitment. In the lung US group, a new protocol for reaeration in US‐guided lung recruitment was used to guide treatment. Evaluation by lung US, respiratory mechanical parameters, the Smith pathologic score (Crit Care Med 1997; 25:1888–1897), and wet‐to‐dry ratio were compared between the groups. Results Opening pressure was significantly higher in the lung US group (mean ± SD, 23.4 ± 3.4 cm H2O) than the oxygenation group (18.7 ± 2.1 cm H2O; P < .05). The reaeration score in the lung US group significantly increased during alveolar recruitment (6.5 ± 1.6 points at baseline versus 13.8 ± 3.0 points after completion; P < .05). Lung compliance, dead space shunts, the Smith pathologic score, and tissue wet‐to‐dry ratio, however, were not significantly different between the groups. Conclusions Lung US is an effective means of evaluating and guiding alveolar recruitment in ARDS. Compared with the maximal oxygenation–guided method, the protocol for reaeration in US‐guided lung recruitment achieved a higher opening pressure, resulted in greater improvements in lung aeration, and substantially reduced lung heterogeneity in ARDS.

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Positive end-expiratory pressure lung recruitment: comparison between lower inflection point and ultrasound assessment

Abstract: In this study, positive end-expiratory pressures for recruitment of subpleural consolidations followed by ultrasound always exceed the pressures measured with LIP. Respecting this, ultrasound method could be the guide for PEEP lung recruitment.

Cited by 21 publications

References 28 publications

Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review

Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review

Lung ultrasound can be used to predict the potential of prone positioning and assess prognosis in patients with acute respiratory distress syndrome

Use of Lung Ultrasound to Assess the Efficacy of an Alveolar Recruitment Maneuver in Rabbits With Acute Respiratory Distress Syndrome

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