Utility of Lung Ultrasound in Adjustment of the Initial Mechanical Ventilation Settings in Patients with ARDS

Abstract

n ARDS, invasive mechanical ventilation with low tidal volume and low / high PEEP is the current management strategy. Although there is agreement about an initial tidal volume of 6 ml/kg ideal body weight, there has been no consensus about the initial level of PEEP. Bedside lung ultrasound is an essential tool in assessing lung aeration in critically ill patients. It could be a reliable tool for assessment of lung recruitment and determining the best ventilator settings in ARDS patients. This study aimed to evaluate the role of lung ultrasound in estimating the changes in lung aeration in the dependent lung regions during a positive end expiratory pressure titration of patients with acute respiratory distress syndrome. This study was a cross sectional study, comprising Fifty - two mechanically ventilated sedated ARDS patients admitted in ICU of Abbassia Chest Hospital during the period between October 2017 and September 2020. Transthoracic sonography was performed at posterior axillary line on either side after 30 minutes of initial ventilator settings; recruitment at the end of expiration was sonographically assessed while changing PEEP. ABGs were performed before and after recruitment maneuver along with continuous monitoring of hemodynamics and oxygen saturation throughout the procedure. The procedure was terminated if the plateau pressure exceeds 30 cm H2o or if there is hemodynamic compromise.