Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore.
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.
Tripathi
Mukesh
M
Department of Anaesthesiology and Critical Care, BPKIHS, Dharan, Nepal. mukesh_tripathi@hotmail.com
Pandey
Mamta
M
Nepal
Bharat
B
Rai
Hari
H
Bhattarai
Balkrishna
B
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