Lung ultrasound in the treatment of alveolar recruitment maneuver for patients with acute respiratory distress syndrome_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HE Huiwei , HE Zhaohui , WANG Rongsheng , CHEN Zhi ,  YANG Chunli

Department of Critical Care Medicine of Jiangxi Province People’s Hospital, Nanchang, Jiangxi 330006, P. R. China;

Corresponding?author：

YANG Chunli, Email: 51418896@qq.com

Keywords：

Lung ultrasound; Maximal oxygenation; Acute respiratory distress syndrome; Alveolar recruitment maneuver; Ultrasound reaeration score

DOI：

10.7507/1671-6205.201704041

Video：

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Objective To Assess the efficacy of using lung ultrasound to guide alveolar recruitment maneuver in patients with acute respiratory distress syndrome (ARDS). Methods Sixty patients with ARDS were randomly divided into two groups, ie, maximal oxygenation group (n=30) and lung ultrasound group (n=30). All the patients had artificial airway and needed mechanical ventilation. The patients in the two groups accepted recruitment maneuver guided by maximal oxygenation or lung ultrasound respectively. During the course of recruitment maneuver, the arterial partial pressure of oxygen (PaO₂), positive end-expiratory pressure (PEEP), central venous pressure (CVP), mean arterial pressure (MAP), cardiac output (CO), and extravascular lung water index (EVLWI) were recorded and compared between both groups. Results The PaO₂ in lung ultrasound group was higher than that in maximal oxygenation group (P=0.04). The PEEP was higher in lung ultrasound group but without significant difference (P=0.910). There was no significant difference of the other outcomes (CVP, MAP, CO, EVLWI) between the two groups (all P>0.05). Conclusion Lung ultrasound is an effective means that has good repeatability and security for guiding recruitment maneuver in patients with ARDS.

Citation： HE Huiwei, HE Zhaohui, WANG Rongsheng, CHEN Zhi, YANG Chunli. Lung ultrasound in the treatment of alveolar recruitment maneuver for patients with acute respiratory distress syndrome. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(6): 591-594. doi: 10.7507/1671-6205.201704041 Copy

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2.	黃英姿, 邱海波. 急性呼吸窘迫綜合征機械通氣策略的現狀與挑戰. 內科理論與實踐, 2010, 5(6): 470-475.
3.	Mercat A, Richard JC, Vielle B. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA, 2008, 299(6): 646-655.
4.	Bouhemad B, Brisson H, Le-Guen M, et al. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med, 2011, 183(3): 341-347.
5.	Li DK, Liu DW, Long Y, et al. 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(12): 2209-2215.
6.	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
7.	王茂華, 劉松橋, 楊毅, 等. 最佳氧合法導向的 PEEP 對 ARDS 綿羊血流動力學和氣體交換的影響. 實用臨床醫藥雜志, 2009, 13(7): 21-24.
8.	Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest, 2015, 147(6): 1659-1670.
9.	The ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
10.	Ma H, Huang DZ, Guo LH, et al. Strong correlation between lung ultrasound and chest computerized tomography imaging for the detection of acute lung injury/acute respiratory distress syndrome in rats. J Thorac Dis, 2016, 8(7): 1443-1448.
11.	Baston C, West TE. Lung ultrasound in acute respiratory distress syndrome and beyond. J Thorac Dis, 2016, 8(12): E1763-E1766.
12.	Wang XT, Ding X, Zhang HM, 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(1): 385.
13.	Ma H, Huang DZ, Zhang MZ, et al. Lung ultrasound is a reliable method for evaluating extravascular lung water volume in rodents. BMC Anesthesiol, 2015, 15: 162.
14.	Vignon P, Repessé X, Vieillard-Baron A, et al. Critical care ultrasonography in acute respiratory failure. Crit Care, 2016, 20(1): 228.

1. Lachmann B. Open up the lung and keep the lung open. Intensive Care Med, 1992, 18(6): 319-321.
2. 黃英姿, 邱海波. 急性呼吸窘迫綜合征機械通氣策略的現狀與挑戰. 內科理論與實踐, 2010, 5(6): 470-475.
3. Mercat A, Richard JC, Vielle B. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA, 2008, 299(6): 646-655.
4. Bouhemad B, Brisson H, Le-Guen M, et al. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med, 2011, 183(3): 341-347.
5. Li DK, Liu DW, Long Y, et al. 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(12): 2209-2215.
6. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
7. 王茂華, 劉松橋, 楊毅, 等. 最佳氧合法導向的 PEEP 對 ARDS 綿羊血流動力學和氣體交換的影響. 實用臨床醫藥雜志, 2009, 13(7): 21-24.
8. Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest, 2015, 147(6): 1659-1670.
9. The ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
10. Ma H, Huang DZ, Guo LH, et al. Strong correlation between lung ultrasound and chest computerized tomography imaging for the detection of acute lung injury/acute respiratory distress syndrome in rats. J Thorac Dis, 2016, 8(7): 1443-1448.
11. Baston C, West TE. Lung ultrasound in acute respiratory distress syndrome and beyond. J Thorac Dis, 2016, 8(12): E1763-E1766.
12. Wang XT, Ding X, Zhang HM, 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(1): 385.
13. Ma H, Huang DZ, Zhang MZ, et al. Lung ultrasound is a reliable method for evaluating extravascular lung water volume in rodents. BMC Anesthesiol, 2015, 15: 162.
14. Vignon P, Repessé X, Vieillard-Baron A, et al. Critical care ultrasonography in acute respiratory failure. Crit Care, 2016, 20(1): 228.

Chinese Journal of Respiratory and Critical Care Medicine

Lung ultrasound in the treatment of alveolar recruitment maneuver for patients with acute respiratory distress syndrome

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