Point-of-care Lung ultrasound assessment of positional changes in COVID-19 ARDS in intensive care: A case report and review of the literature.

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.