Lung ultrasound can predict response to the prone position in awake non-intubated patients with COVID‑19 associated acute respiratory distress syndrome

Avdeev, Sergey N.; Nekludova, Galina V.; Trushenko, Natalia V.; Tsareva, Natalia A.; Yaroshetskiy, Andrey I.; Kosanovic, Djuro

doi:10.1186/s13054-021-03472-1

Critical Care

Table 1 Comparison of changes over time in respiratory variables in responders and non-responders

From: Lung ultrasound can predict response to the prone position in awake non-intubated patients with COVID‑19 associated acute respiratory distress syndrome

Parameters	Non-responders	Responders	p value
LUS (total aeration) score, baseline	18.5 (16.0–20.3)	17.5 (17.0–20.8)	0.97
LUS (total aeration) score, PP at 3 h	16.0 (14.5–18.8)	13.5 (12.3–14.0)	0.03
LUS (posterior segments) score, baseline	6.0 (4.3–7.3)	8.5 (7.3–9.8)	0.006
LUS (posterior segments) score, PP at 3 h	5.5 (4.0–6.0)	4.0 (4.0–5.0)	0.20
LUS (anterior segments) score, baseline	6.0 (5.3–7.5)	5.0 (4.0–5.0)	0.05
LUS (anterior segments) score, PP at 3 h	6.5 (4.3–7.3)	5.0 (4.0–6.0)	0.11
LUS (lateral segments) score, baseline	6.0 (4.8–7.5)	5.5 (4.0–6.0)	0.37
LUS (lateral segments) score, PP at 3 h	5.0 (4.5–7.3)	4.0 (3.0–5.0)	0.07
PaO₂/FiO₂ at baseline	138 (113–177)	136 (118–172)	0.53
PaO₂/FiO₂ PP at 3 h	148 (128–182)	181 (174–210)	0.03
PaCO₂ at baseline	36 (34–41)	37 (34–40)	0.94
PaCO₂ PP at 3 h	36 (34–40)	37 (35–38)	0.92
SpO₂/FiO₂ at baseline	181 (176–228)	180 (177–211)	0.86
SpO₂/FiO₂ PP at 15 min	183 (178–230)	190 (188–222)	0.07
SpO₂/FiO₂ PP at 3 h	185 (178–224)	194 (193–233)	0.07
SpO₂/FiO₂ supine at 15 min	182 (179–226)	188 (184–227)	0.08
SpO₂/FiO₂ supine at 1 h	179 (176–226)	184 (182–215)	0.13
RR at baseline	23 (22–26)	24 (20–26)	0.91
RR PP at 15 min	22 (19–26)	21 (20–24)	0.65
RR PP at 3 h	21 (18–27)	19 (16–21)	0.08
RR supine at 15 min	23 (22–26)	20 (18–23)	0.02
RR supine at 1 h	24 (22–26)	23 (18–25)	0.29
HR at baseline	79 (72–93)	81 (79–94)	0.24
HR PP at 15 min	91 (73–100)	88 (76–98)	0.12
HR PP at 3 h	85 (79–97)	74 (70–91)	0.20
HR supine at 15 min	81 (76–88)	89 (80–97)	0.88
HR supine at 1 h	86 (75–104)	79 (74–88)	0.37
Dyspnea Borg at baseline	5 (3–6)	5 (3–6)	0.89
Dyspnea Borg PP at 15 min	4 (2–6)	4 (2–6)	0.95
Dyspnea Borg PP at 3 h	5 (3–7)	3 (2–4)	0.26
Dyspnea Borg supine at 15 min	4 (3–6)	3 (2–6)	0.43
Dyspnea Borg supine at 1 h	5 (4–6)	4 (2–5)	0.12

The study protocol included the measurement of SpO₂, respiratory rate (RR), heart rate (HR) and dyspnea assessment using Borg-Dyspnea-Scale (at baseline, after 15 min in PP, after 3 h in PP, 15 min and 1 h after turning in supine position). Arterial blood gas analysis was measured twice: at baseline and after 3 h in PP. The increase of PaO₂/FiO₂ by 20 mmHg in 3 h after turning a patient into the prone position was used as the criterion of the response to PP. All parameters of respiratory support and FiO₂ were the same during supine and prone positions. Before PP and after 3 h in PP semi-quantitative assessment of the lung tissue was performed by LUS. The study protocol included 14 areas for scanning (two anterior, two lateral and three posterior regions of each hemithorax) [4]
Data are expressed as median (inter-quartile range). PaO₂/FiO₂ (mmHg): arterial oxygen tension to inspired oxygen fraction ratio; PaCO₂ (mmHg): arterial carbon dioxide tension; SpO₂/FiO₂: arterial oxygen saturation to inspired oxygen fraction ratio; RR (min⁻¹): respiratory rate, HR (min⁻¹): heart rate; LUS: lung ultrasound; PP: prone position

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ISSN: 1364-8535

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