Previous article Table of Contents  Next article

REVIEW ARTICLE
Year : 2018  |  Volume : 12  |  Issue : 3  |  Page : 457-461

Lung ultrasound: Predictor of acute respiratory distress syndrome in intensive care unit patients


1 Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
2 Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
3 Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
4 Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

Correspondence Address:
Dr. Xuezheng Zhang
Department of Anesthesiology, First Affiliated Hospital of Wenzhou Medical University, 637 South Baixiang Street, Wenzhou, Zhejiang 325000
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_73_18

Rights and Permissions
Date of Web Publication2-Jul-2018
 

  Abstract 


Purpose: The purpose of the study was to review and summarize current literature concerning the validation and application of lung ultrasound (LUS) in critically ill patients with acute respiratory distress syndrome (ARDS).
Materials and Methods: An extensive literature search was conducted using PubMed, Cochrane Review, Google Scholar, and Ohio State University Link based on the question if LUS should be considered a reliable investigational technique for ARDS diagnosis, treatment, and prognosis in pediatric and adult population.
Results: LUS has been successfully validated for facilitating early diagnosis and diagnosis of simultaneous lung conditions, predicting lung recruitment treatment effect, and evaluating the prognosis in ARDS patients. Whether lung US is a useful tool in the prediction of prone position and oxygenation response in patients with ARDS is conflicting.
Conclusions: LUS is a noninvasive, radiation-free, cheap, and easy to perform tool for critically ill patients with ARDS and might be a promising technique used in the Intensive Care Unit for ARDS management.

Keywords: Acute respiratory distress syndrome; extravascular lung water indices; Intensive Care Unit; lung recruitment maneuvers; lung ultrasound; prone positioning oxygenation response


How to cite this article:
Zhou Y, Fan Q, Cavus O, Zhang X. Lung ultrasound: Predictor of acute respiratory distress syndrome in intensive care unit patients. Saudi J Anaesth 2018;12:457-61

How to cite this URL:
Zhou Y, Fan Q, Cavus O, Zhang X. Lung ultrasound: Predictor of acute respiratory distress syndrome in intensive care unit patients. Saudi J Anaesth [serial online] 2018 [cited 2018 Jul 20];12:457-61. Available from: http://www.saudija.org/text.asp?2018/12/3/457/235766




  Introduction Top


Acute respiratory distress syndrome (ARDS) is characterized by diffuse alveolar damage associated with an increase in alveolar and capillary permeability, leading to interstitial and alveolar edema that requires mechanical ventilation. According to the Berlin definition, the diagnosis of ARDS is based on the onset of hypoxemia and bilateral chest opacities developed within 1 week from the initial symptoms.[1] ARDS is a common cause of mortality in the Intensive Care Unit (ICU); although the mortality rate is declining (while still 50%), the long-term morbidity is still considerable.[2],[3],[4],[5] A cornerstone of treating patients affected by ARDS is mechanical ventilation, tailored to avoid ventilator-induced lung injury and lung collapse. Lung computed tomography (CT) scan can provide useful diagnostic information and assess the benefit of treatment. However, this procedure is done in a CT unit under cardiorespiratory monitoring with an increased risk to the patient.[6],[7],[8],[9]

Diagnostic and lung exploratory ultrasound is a rapidly evolving technique used in the ICU environment, being considered noninvasive, radiation-free, cheap, and easy to perform.[10] Lung ultrasound (LUS) has been validated for hemodynamic management, pleural effusions, pulmonary edema, pneumothorax detection, parenchymal consolidation, and central vein catheter placement.[11],[12],[13],[14],[15] Li et al. used ultrasound in rabbits with ARDS to assess the efficacy of an alveolar recruitment maneuver. The authors concluded that LUS is an effective method of evaluating and guiding alveolar recruitment in ARDS rabbits.[16] Stefanidis et al. considered that lung sonography is a useful clinical tool for ARDS patients.[17] Prat et al. demonstrated that a simple and short LUS examination could predict prone position oxygenation response in ARDS patients.[18]


  Materials and Methods Top


Based on this published evidence, we question if lung ultrasonography should be considered a reliable investigational technique for ARDS diagnosis, management, and prognosis in pediatric and adult population. We initiated a comprehensive review of literature using the following keywords: LUS, ARDS, ICU, recruitment treatment, prone positioning (PP), and extravascular lung water when accessing PubMed, Cochrane Review, Google Scholar, and Ohio State University Link.


  Results and Discussion Top


Lung ultrasound and acute respiratory distress syndrome diagnosis

Lung ultrasound facilitates early diagnosis of acute respiratory distress syndrome

Several studies proved the advantage of LUS technique in the early diagnose of ARDS. Gargani et al. showed that LUS could detect extravascular lung water accumulation early during the oleic acid lung injury, in the presence of a normal PaO2/FiO2.[19] LUS can also predict trauma patients at risk of developing ARDS. Leblanc et al. performed chest radiography and LUS on 45 blunt trauma patients with ARDS. Lung contusion extent was quantified using a LUS score that was compared to CT scan measurements. The ability of the LUS score to predict ARDS was tested using the area under the receiver operating characteristic curve. The diagnostic accuracy of LUS versus combined clinical examination and chest radiography with CT scan as reference was tested in blunt trauma patients. The authors concluded that LUS could identify patients at risk for developing ARDS after suffering blunt trauma. A LUS score of 6 out of 16 was the best threshold to predict ARDS, with a 58% sensitivity and a 96% specificity. In addition, the diagnostic accuracy of LUS was higher than clinical examination combined with chest radiography.[20]

LUS helps differential diagnosis of patients with “white” lungs at standard chest X-ray, excluding conditions such as pleural effusions or cardiogenic pulmonary edema.[21] Sekiguch et al.'s study enrolled 134 patients (median PaO2/FiO2 ratio, 191 and interquartile range, 122–253). Combined cardiac and LUS assist in the early differential diagnosis of ARDS, cardiogenic pulmonary edema, and other causes of hypoxemic respiratory failure.[22] In clinical applications, Zhang et al. used lung ultrasonography to diagnose 11 patients with ARDS due to bird flu H7N9 infection. They showed that bedside ultrasound can be used to evaluate H7N9 avian influenza infection in patients with ARDS, providing a strong basis for adjusting the treatment plan for patients. Therefore, LUS could be useful for the timely monitoring of ARDS caused by the H7N9 virus in clinics,[23] especially in resource-scarce settings or situations such as future respiratory virus outbreaks or pandemics.[24]

Lung ultrasound helps to diagnose coexisting pathology in acute respiratory distress syndrome patients

As ARDS aggravates, lung consolidation, atelectasis, pleural effusion, and pneumothorax will develop. LUS can also accurately diagnose and assess the severity of lung simultaneous conditions. Xirouchaki et al. conducted a prospective study using a modified LUS protocol based on 42 mechanically ventilated patients scheduled for CT. Four pathologic entities were evaluated: consolidation, interstitial syndrome, pneumothorax, and pleural effusion. The study proved that LUS has a considerably better diagnostic performance than chest X-ray when identifying coexisting conditions.[14]

A semi-quantitative, simple, and noninvasive index of lung water accumulation can be assessed by LUS identifying B-lines (also called ultrasound lung comets).[25] Thickened interlobular septa generate B-lines 7 mm apart and are associated with interstitial edema, while ground-glass areas characterizing alveolar edema are generating B-lines ≤3 mm.[26] The number of B-line reflects the extent of pulmonary edema. Per Lichtenstein et al. “when 3 or more B-lines are seen, interstitial edema can be diagnosed with 97% sensitivity and 95% specificity.”[27] Recently, a modified Berlin definition of ARDS has introduced LUS as a based tool to detect bilateral lung opacities and to assess incidence and outcomes of ARDS patients in resource-constrained settings.[1]

Lung ultrasound ability to predict treatment outcome in acute respiratory distress syndrome patients

Lung ultrasound ability to predict lung recruitment treatment effect in acute respiratory distress syndrome patients

Patients with ARDS invariably require mechanical ventilation to decrease the work of breathing and to improve oxygen transport. An improvement in oxygenation can be obtained by increasing positive end-expiratory pressure (PEEP), a strategy that was proposed when ARDS was initially described in 1967.[28] Stefanidis et al. performed lung US in ten patients with ARDS to depict the nonaerated area in the dependent lung regions at different PEEP settings of 5, 10, and 15 cm H2O. Sonographic assessment of the nonaerated lung area and arterial blood gas analysis were performed simultaneously at the end of each period. The results indicated that nonaerated areas in the dependent lung regions were significantly reduced when increasing PEEP, and these changes were associated with a subsequent increase in arterial oxygen partial pressure. According to the authors, lung sonography can detect the nonaerated lung area changes during a PEEP trial of patients with ARDS. Thus, transthoracic lung sonography might be considered a useful clinical tool during ARDS management.[17]

A prospective study, including 40 consecutive patients with ARDS, demonstrated that LUS can be used as a reliable tool for assessing PEEP-induced lung recruitment at the bedside. A significant correlation was found between the ultrasound reaeration score and PEEP-induced lung recruitment measured by pressure-volume curves. The authors considered that LUS is not the sole method for PEEP titration because its failure to assess PEEP-induced lung hyperinflation.[29] Same authors compared lung reaeration measured by bedside chest radiography, and LUS in patients with ventilator-associated pneumonia treated by antibiotics. The study concluded that chest radiography was inaccurate in predicting lung reaeration. LUS accurately estimates lung reaeration in patients with ventilator-associated pneumonia on antibiotic therapy.[30]

ARDS affects children with an incidence of 12 cases/100,000 person-years with under-recruited lungs owing to inflammatory edema. Lung recruitment maneuvers are challenging and often performed by the critical care physicians and pediatric intensivists when CT or pulmonary mechanic measurements are not easily accessible.[31],[32] Recently, lung ultrasonography has been applied successfully in critical care patients aiming to obtain reliable, fast, and continuous evaluation.[33] Santuz et al. reported a case of 2-month old infant with severe ARDS and lung recruitment maneuver assisted by LUS. This is the first report of a successful lung recruitment maneuvers using LUS in pediatric ARDS.[34] Sameshima et al. described a case of US-guided lung recruitment procedure applied in an infant with severe ARDS and advocated that the lung US-guided recruitment maneuvers in infants are a feasible and safe procedure.[35]

Lung ultrasound ability to predict prone positioning response in acute respiratory distress syndrome patients

PP has been accepted as one of the important therapeutic strategies for ARDS patients.[36] Several studies have shown that PP could improve oxygenation,[37],[38] reduce ventilation-induced lung injury, and decrease mortality.[39],[40] However, the method may involve risks of unintended extubation and hemodynamic disturbance.[41] It is important to assess the effectiveness of PP in patients with severe ARDS and to predict whether these patients can benefit from the procedure. Prat et al. assessed whether lung US is a useful tool in prediction of PP oxygenation response in patients with ARDS. According to their prospective study, 19 ARDS patients were assessed for at least 12 h [42] with six different ultrasonography windows. Patients were classified into two groups (responders/non responders) according to their oxygenation response to PP. The normal aspect of the anterobasal regions, evaluated by LUS, was significantly associated with the oxygenation response (P = 0.0436), with a positive predictive value equal to or near 100%.[18] A similar study showed that the PP LUS examination protocol can be used to predict PP potential and assess prognosis in patients with ARDS.[43]

A multicenter prospective study included 51 adult patients with severe and moderate ARDS and used LUS to assess oxygenation response to PP ventilation. LUS was performed at four time points, 1 h before (baseline) and 1 h after turning the patient to PP, 1 h before and 1 h after turning the patient back to the supine position. Regional lung aeration changes and ultrasound reaeration scores were assessed at each time. The authors reported negative results that oxygenation response after PP was not correlated with a specific LUS pattern.[44]

Lung ultrasound evaluates the prognosis of patients with acute respiratory distress syndrome

An early assessment of the severity of ARDS and identification of coexisting conditions are essential to implement the treatment and to improve the prognosis. Based on prospective data, Li et al. indicated that LUS had a positive correlation with the following “traditional parameters” used to assess the severity and prognosis of ARDS: Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, and Clinical Pulmonary Infection Score. The authors concluded that LUS can be a valuable tool when evaluating the changes in pulmonary ventilation associated with ARDS, the severity, prognosis, and prediction of mortality in ARDS patients.[45]

The prognostic value of extravascular lung water indices for patients with ARDS is widely accepted.[46] Patients with high indexed EVLI have the more serious lung injury and a worse prognosis. Significant positive linear correlations between LUS and EVLW were found by a recent published prospective study. The authors concluded that LUS is a simple and economic approach for predicting the prognosis of ARDS patients and can serve as a diagnostic marker of this disease.[47]

The limitations of lung ultrasound for acute respiratory distress syndromepatients

When applying LUS in ARDS patients, several limitations should be considered. First, the presence of draining tube and multicatheter can interfere with the appropriate placement of the transducer and reading of the result. Second, obesity may prevent clear imaging of targeted body area because of the rib cage thickness. Third, the technique's efficiency is limited in patients with subcutaneous emphysema or large thoracic dressings. Finally, subjectivity must be considered when interpreting the LUS according to the providers' skills and experience.[48]


  Conclusions Top


The limitations of LUS are not essential when considering its diagnosis and prognosis capabilities for patients with ARDS. It is an easily available, user-friendly, and cost-effective medical technique that involves no ionizing radiation. It is complementary to bedside chest X-ray and reduces the need to use a CT scan. LUS is a helpful tool used to diagnose, treat, and predict the prognosis of ARDS patients.

Acknowledgment

We acknowledge Dr. Nicoleta Stoicea for her contribution on building up references for our review.

Financial support and sponsorship

This work was supported by Wenzhou science and Technology Bureau (grant number Y20150019, 2015) and The National Key Technology Research and Development Program of the Ministry of Science and Technology of China (grand number 2012BAI11B02, 2012).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Riviello ED, Kiviri W, Twagirumugabe T, Mueller A, Banner-Goodspeed VM, Officer L, et al. Hospital incidence and outcomes of the acute respiratory distress syndrome using the Kigali modification of the Berlin definition. Am J Respir Crit Care Med 2016;193:52-9.  Back to cited text no. 1
    
2.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818-24.  Back to cited text no. 2
[PUBMED]    
3.
Fanelli V, Vlachou A, Ghannadian S, Simonetti U, Slutsky AS, Zhang H, et al. Acute respiratory distress syndrome: New definition, current and future therapeutic options. J Thorac Dis 2013;5:326-34.  Back to cited text no. 3
    
4.
Wheeler AP, Bernard GR. Acute lung injury and the acute respiratory distress syndrome: A clinical review. Lancet 2007;369:1553-64.  Back to cited text no. 4
[PUBMED]    
5.
Obadina ET, Torrealba JM, Kanne JP. Acute pulmonary injury: High-resolution CT and histopathological spectrum. Br J Radiol 2013;86:20120614.  Back to cited text no. 5
[PUBMED]    
6.
Tagliabue M, Casella TC, Zincone GE, Fumagalli R, Salvini E. CT and chest radiography in the evaluation of adult respiratory distress syndrome. Acta Radiol 1994;35:230-4.  Back to cited text no. 6
[PUBMED]    
7.
Goodman LR, Fumagalli R, Tagliabue P, Tagliabue M, Ferrario M, Gattinoni L, et al. Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations. Radiology 1999;213:545-52.  Back to cited text no. 7
[PUBMED]    
8.
Rouby JJ, Puybasset L, Nieszkowska A, Lu Q. Acute respiratory distress syndrome: Lessons from computed tomography of the whole lung. Crit Care Med 2003;31:S285-95.  Back to cited text no. 8
[PUBMED]    
9.
Desai SR, Wells AU, Suntharalingam G, Rubens MB, Evans TW, Hansell DM, et al. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary injury: A comparative CT study. Radiology 2001;218:689-93.  Back to cited text no. 9
    
10.
Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part II: Cardiac ultrasonography. Crit Care Med 2016;44:1206-27.  Back to cited text no. 10
[PUBMED]    
11.
Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, et al. American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. Chest 2009;135:1050-60.  Back to cited text no. 11
[PUBMED]    
12.
Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012;38:577-91.  Back to cited text no. 12
[PUBMED]    
13.
Vezzani A, Brusasco C, Palermo S, Launo C, Mergoni M, Corradi F, et al. Ultrasound localization of central vein catheter and detection of postprocedural pneumothorax: An alternative to chest radiography. Crit Care Med 2010;38:533-8.  Back to cited text no. 13
    
14.
Xirouchaki N, Magkanas E, Vaporidi K, Kondili E, Plataki M, Patrianakos A, et al. Lung ultrasound in critically ill patients: Comparison with bedside chest radiography. Intensive Care Med 2011;37:1488-93.  Back to cited text no. 14
[PUBMED]    
15.
Gardelli G, Feletti F, Nanni A, Mughetti M, Piraccini A, Zompatori M, et al. Chest ultrasonography in the ICU. Respir Care 2012;57:773-81.  Back to cited text no. 15
    
16.
Li DK, Liu DW, Long Y, Wang XT. Use of lung ultrasound to assess the efficacy of an alveolar recruitment maneuver in rabbits with acute respiratory distress syndrome. J Ultrasound Med 2015;34:2209-15.  Back to cited text no. 16
[PUBMED]    
17.
Stefanidis K, Dimopoulos S, Tripodaki ES, Vitzilaios K, Politis P, Piperopoulos P, et al. Lung sonography and recruitment in patients with early acute respiratory distress syndrome: A pilot study. Crit Care 2011;15:R185.  Back to cited text no. 17
[PUBMED]    
18.
Prat G, Guinard S, Bizien N, Nowak E, Tonnelier JM, Alavi Z, et al. Can lung ultrasonography predict prone positioning response in acute respiratory distress syndrome patients? J Crit Care 2016;32:36-41.  Back to cited text no. 18
[PUBMED]    
19.
Gargani L, Lionetti V, Di Cristofano C, Bevilacqua G, Recchia FA, Picano E, et al. Early detection of acute lung injury uncoupled to hypoxemia in pigs using ultrasound lung comets. Crit Care Med 2007;35:2769-74.  Back to cited text no. 19
    
20.
Leblanc D, Bouvet C, Degiovanni F, Nedelcu C, Bouhours G, Rineau E, et al. Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients. Intensive Care Med 2014;40:1468-74.  Back to cited text no. 20
[PUBMED]    
21.
Pesenti A, Musch G, Lichtenstein D, Mojoli F, Amato MB, Cinnella G, et al. Imaging in acute respiratory distress syndrome. Intensive Care Med 2016;42:686-98.  Back to cited text no. 21
    
22.
Sekiguchi H, Schenck LA, Horie R, Suzuki J, Lee EH, McMenomy BP, et al. Critical care ultrasonography differentiates ARDS, pulmonary edema, and other causes in the early course of acute hypoxemic respiratory failure. Chest 2015;148:912-8.  Back to cited text no. 22
[PUBMED]    
23.
Zhang YK, Li J, Yang JP, Zhan Y, Chen J. Lung ultrasonography for the diagnosis of 11 patients with acute respiratory distress syndrome due to bird flu H7N9 infection. Virol J 2015;12:176.  Back to cited text no. 23
[PUBMED]    
24.
Tsai NW, Ngai CW, Mok KL, Tsung JW. Lung ultrasound imaging in avian influenza A (H7N9) respiratory failure. Crit Ultrasound J 2014;6:6.  Back to cited text no. 24
[PUBMED]    
25.
Jambrik Z, Gargani L, Adamicza A, Kaszaki J, Varga A, Forster T, et al. B-lines quantify the lung water content: A lung ultrasound versus lung gravimetry study in acute lung injury. Ultrasound Med Biol 2010;36:2004-10.  Back to cited text no. 25
[PUBMED]    
26.
Bouhemad B, Zhang M, Lu Q, Rouby JJ. Clinical review: Bedside lung ultrasound in critical care practice. Crit Care 2007;11:205.  Back to cited text no. 26
[PUBMED]    
27.
Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: The BLUE protocol. Chest 2008;134:117-25.  Back to cited text no. 27
    
28.
Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967;2:319-23.  Back to cited text no. 28
[PUBMED]    
29.
Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ, et al. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med 2011;183:341-7.  Back to cited text no. 29
    
30.
Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le-Guen M, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med 2010;38:84-92.  Back to cited text no. 30
[PUBMED]    
31.
Zimmerman JJ, Akhtar SR, Caldwell E, Rubenfeld GD. Incidence and outcomes of pediatric acute lung injury. Pediatrics 2009;124:87-95.  Back to cited text no. 31
[PUBMED]    
32.
Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 2006;354:1775-86.  Back to cited text no. 32
[PUBMED]    
33.
Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. J Am Soc Anesthesiol 2004;100:9-15.  Back to cited text no. 33
    
34.
Santuz P, Bonetti P, Serra A, Biban P. Correspondence: Ultrasound-guided lung recruitment in a young infant with ARDS. Pediatr Anesth 2010;20:895-6.  Back to cited text no. 34
    
35.
Sameshima YT, Lourenço de Almeida JF, Silva MM, Remondini R, Haddad LB, Neto MJ, et al. Ultrasound-guided lung recruitment in a 3-month-old infant with acute respiratory distress syndrome. Ultrasound Q 2014;30:301-5.  Back to cited text no. 35
    
36.
Guérin C. Prone position. Curr Opin Crit Care 2014;20:92-7.  Back to cited text no. 36
    
37.
Abroug F, Ouanes-Besbes L, Elatrous S, Brochard L. The effect of prone positioning in acute respiratory distress syndrome or acute lung injury: A meta-analysis. Areas of uncertainty and recommendations for research. Intensive Care Med 2008;34:1002-11.  Back to cited text no. 37
[PUBMED]    
38.
Sud S, Friedrich JO, Taccone P, Polli F, Adhikari NK, Latini R, et al. Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: Systematic review and meta-analysis. Intensive Care Med 2010;36:585-99.  Back to cited text no. 38
[PUBMED]    
39.
Galiatsou E, Kostanti E, Svarna E, Kitsakos A, Koulouras V, Efremidis SC, et al. Prone position augments recruitment and prevents alveolar overinflation in acute lung injury. Am J Respir Crit Care Med 2006;174:187-97.  Back to cited text no. 39
[PUBMED]    
40.
Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368:2159-68.  Back to cited text no. 40
    
41.
Taccone P, Pesenti A, Latini R, Polli F, Vagginelli F, Mietto C, et al. Prone positioning in patients with moderate and severe acute respiratory distress syndrome: A randomized controlled trial. JAMA 2009;302:1977-84.  Back to cited text no. 41
[PUBMED]    
42.
L'Her E, Renault A, Oger E, Robaux MA, Boles JM. A prospective survey of early 12-h prone positioning effects in patients with the acute respiratory distress syndrome. Intensive Care Med 2002;28:570-5.  Back to cited text no. 42
    
43.
Wang XT, Ding X, Zhang HM, Chen H, Su LX, Liu DW, et al. Lung ultrasound can be used to predict the potential of prone positioning and assess prognosis in patients with acute respiratory distress syndrome. Crit Care 2016;20:385.  Back to cited text no. 43
    
44.
Haddam M, Zieleskiewicz L, Perbet S, Baldovini A, Guervilly C, Arbelot C, et al. Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS. Intensive Care Med 2016;42:1546-56.  Back to cited text no. 44
[PUBMED]    
45.
Li L, Yang Q, Li L, Guan J, Liu Z, Han J, et al. The value of lung ultrasound score on evaluating clinical severity and prognosis in patients with acute respiratory distress syndrome. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2015;27:579-84.  Back to cited text no. 45
[PUBMED]    
46.
Jozwiak M, Teboul JL, Monnet X. Extravascular lung water in critical care: Recent advances and clinical applications. Ann Intensive Care 2015;5:38.  Back to cited text no. 46
    
47.
Zhao Z, Jiang L, Xi X, Jiang Q, Zhu B, Wang M, et al. Prognostic value of extravascular lung water assessed with lung ultrasound score by chest sonography in patients with acute respiratory distress syndrome. BMC Pulm Med 2015;15:98.  Back to cited text no. 47
[PUBMED]    
48.
Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care 2014;4:1.  Back to cited text no. 48
[PUBMED]    




 

Top
 
Previous article    Next article
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  IN THIS Article
   Abstract
  Introduction
   Materials and Me...
   Results and Disc...
  Conclusions
   References

 Article Access Statistics
    Viewed115    
    Printed1    
    Emailed0    
    PDF Downloaded37    
    Comments [Add]    

Recommend this journal