title: Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore.
abstract: BACKGROUND
  Mechanical ventilation with positive end expiratory pressure (PEEP) is associated with unequal aeration of lungs in acute respiratory distress syndrome (ARDS) patients. Therefore, patients may develop asymmetric atelectasis and postural hypoxemia during lateral positioning.
  
  
  OBJECTIVE
  To validate proposed lung infiltration score (LIS) based on chest x-ray to predict postural hypoxemia and lateralization of skin sores in ARDS patients.
  
  
  METHODS
  University hospital ICU. Prospective, observational study of consecutive patients.
  
  
  METHODS
  Sixteen adult patients of both genders on mechanical ventilation with PEEP for 24 to <48 hours. On chest x-ray, 6 segments were identified on each lung. The proposed LIS points (0- normal; 1- patchy infiltrates; 2- white infiltrates matching heart shadow) were assigned to each segment. Without changing ventilation parameters, supine, left and right lateral positions at 45 degrees tilt were randomly changed. At the end of 20 minutes of ventilation in each position, we observed arterial oxygen saturation, hemodynamic and arterial blood gases. Later, position change protocol (4 hourly) was practiced in ICU, and skin pressure sore grading was noted within a week of ICU stay.
  
  
  METHODS
  Nonparametric Bland and Altman correlation analysis, ANOVA and Student t test.
  
  
  RESULTS
  Arterial oxygenation (PaO2/FiO2 = 313 +/- 145.6) was significantly (P<0.01) higher in better lung (lower LIS)-down position than supine (PaO2/FiO2 = 199 +/- 70.2) or a better lung-up position (PaO2/FiO2 = 165 +/- 64.8). The positioning-related arterial oxygenation was significant (P<0.05) at LIS asymmetry > or =3 between two lungs.
  
  
  CONCLUSIONS
  The LIS mapping on chest x-ray was useful to differentiate between asymmetric lung disease and postural hypoxemia in ICU patients, which predisposed patients to early skin sore changes on higher LIS side.
authors.affiliation: Department of Anaesthesiology and Critical Care, BPKIHS, Dharan, Nepal. mukesh_tripathi@hotmail.com
authors.forename: Mukesh
authors.initials: M
authors.lastname: Tripathi
authors.forename: Mamta
authors.initials: M
authors.lastname: Pandey
authors.forename: Bharat
authors.initials: B
authors.lastname: Nepal
authors.forename: Hari
authors.initials: H
authors.lastname: Rai
authors.forename: Balkrishna
authors.initials: B
authors.lastname: Bhattarai
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D007362:Intensive Care Units; D008168:Lung; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011175:Positive-Pressure Respiration; D003668:Pressure Ulcer / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D001261:Pulmonary Atelectasis; D011859:Radiography; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D012307:Risk Factors; D012867:Skin / Q000473:pathology*; D018709:Statistics, Nonparametric; D055815:Young Adult