Lung Ultrasound and Electrical Impedance Tomography During Ventilator-Induced Lung Injury*

医学 肺超声 超声波 放射科 电阻抗断层成像 计算机断层摄影术 断层摄影术 内科学
作者
Irene Steinberg,Iacopo Pasticci,Mattia Busana,Andrea Costamagna,G. Hahn,Simone Gattarello,Paola Palermo,Stefano Lazzari,Federica Romitti,Peter Herrmann,Onnen Moerer,Leif Saager,Konrad Meissner,Michael Quintel,Luciano Gattinoni
出处
期刊:Critical Care Medicine [Lippincott Williams & Wilkins]
卷期号:50 (7): e630-e637 被引量:11
标识
DOI:10.1097/ccm.0000000000005479
摘要

Lung damage during mechanical ventilation involves lung volume and alveolar water content, and lung ultrasound (LUS) and electrical impedance tomography changes are related to these variables. We investigated whether these techniques may detect any signal modification during the development of ventilator-induced lung injury (VILI).Experimental animal study.Experimental Department of a University Hospital.Forty-two female pigs (24.2 ± 2.0 kg).The animals were randomized into three groups (n = 14): high tidal volume (TV) (mean TV, 803.0 ± 121.7 mL), high respiratory rate (RR) (mean RR, 40.3 ± 1.1 beats/min), and high positive-end-expiratory pressure (PEEP) (mean PEEP, 24.0 ± 1.1 cm H2O). The study lasted 48 hours. At baseline and at 30 minutes, and subsequently every 6 hours, we recorded extravascular lung water, end-expiratory lung volume, lung strain, respiratory mechanics, hemodynamics, and gas exchange. At the same time-point, end-expiratory impedance was recorded relatively to the baseline. LUS was assessed every 12 hours in 12 fields, each scoring from 0 (presence of A-lines) to 3 (consolidation).In a multiple regression model, the ratio between extravascular lung water and end-expiratory lung volume was significantly associated with the LUS total score (p < 0.002; adjusted R2, 0.21). The variables independently associated with the end-expiratory difference in lung impedance were lung strain (p < 0.001; adjusted R2, 0.18) and extravascular lung water (p < 0.001; adjusted R2, 0.11).Data suggest as follows. First, what determines the LUS score is the ratio between water and gas and not water alone. Therefore, caution is needed when an improvement of LUS score follows a variation of the lung gas content, as after a PEEP increase. Second, what determines the end-expiratory difference in lung impedance is the strain level that may disrupt the intercellular junction, therefore altering lung impedance. In addition, the increase in extravascular lung water during VILI development contributed to the observed decrease in impedance.
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