Point-of-care lung ultrasound assessment of positional changes in COVID-19 ARDS in intensive care: a case report and review of the literature
Author(s)
Koca, Oguzhan
Koksal, Guniz
Type
Journal Article
Abstract
Prone positioning is a cornerstone in the management of acute respiratory distress syndrome (ARDS), including COVID-19-related ARDS. However, alternative positioning strategies such as reverse Trendelenburg position (RTP) have received limited attention. The objective is to evaluate the physiological effects of RTP on lung aeration using lung ultrasound (LUS) in a patient with severe COVID-19 ARDS. We performed serial LUS assessments across 12 lung regions in a mechanically ventilated ARDS patient undergoing three different positional changes: Trendelenburg, flat supine/prone, and reverse Trendelenburg. LUS scores were used to quantify regional aeration and global lung aeration. Oxygenation parameters were monitored in parallel. RTP was associated with a reduction in global LUS score (from 21 to 17), indicating improved lung aeration, particularly in the superior and posterior regions. Oxygenation improved concurrently, with increases in peripheral and central venous oxygen saturations. No significant change in lung compliance was observed. This case demonstrates that RTP may facilitate redistribution of extravascular lung water and improve aeration in select lung regions. LUS offers a dynamic, noninvasive method to assess and guide individualized positioning strategies in ARDS. These findings support further exploration of vertical positioning as an adjunct in ARDS management when prone positioning is not feasible.
Date Issued
2025-08-01
Date Acceptance
2025-07-14
Citation
Physiological Reports, 2025, 13 (16)
ISSN
2051-817X
Publisher
Wiley
Journal / Book Title
Physiological Reports
Volume
13
Issue
16
Copyright Statement
© 2025 The Author(s). Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Publication Status
Published
Article Number
e70484
Date Publish Online
2025-08-22