Log in | Register

Whole lung lavage: a unique model for ultrasound assessment of lung aeration changes

Gabriele Via| Daniel Lichtenstein| Francesco Mojoli| Giuseppe Rodi| Luca Neri| Enrico Storti| Catherine Klersy| Giorgio Iotti| Antonio Braschi
Original
Volume 36, Issue 6 / June , 2010

Pages 999 - 1007

Abstract

Purpose

Whole lung lavage (WLL) pathophysiologically represents a human model of controlled lung de-aeration, resembling various pathological conditions encountered in the critically ill. Through one-lung ventilation and progressive alveolar flooding, it mimics, respectively, re-absorption atelectasis formation and lung consolidation. With re-ventilation of the treated lung, PEEP application and diuretics administration, it then creates a model of pulmonary edema and its progressive resolution. No studies have so far described lung aeration changes during WLL with ultrasound: objectives of the study were to describe ultrasound findings during WLL with validated semiotics in the critically ill and to investigate their relation with the lung’s state of relative aeration.

Methods

In seven patients, 12 lung areas/patient were prospectively studied with ultrasound during six procedural steps of WLL. A three-tiered pattern classification was assigned (1, normal/nearly normal; 2, alveolar-interstitial syndrome; 3, alveolar consolidation) consistently with their previously described meaning in terms of relative air content. The distribution was compared throughout different WLL maneuvers as it was for arterial oxygen measurement distribution.

Results

During one-lung ventilation and saline flooding, ultrasound findings shifted from artifact patterns (normal/nearly normal and alveolar-interstitial syndrome) to alveolar consolidation. Saline removal, re-ventilation and negative water balance were associated with a gradual return to alveolar-interstitial syndrome, then to a normal/nearly normal pattern. Arterial oxygen tension variations were not always consistent with these changes.

Conclusions

In a controlled human model of lung air content variation, the different states of aeration determined by WLL procedure were reliably described with lung ultrasound.

Keywords

References

  1. Lichtenstein D (2007) Ultrasound in the management of thoracic disease. Crit Care Med 35:S250–S261
    • View reference on publisher's website
    • View reference on PubMed
  2. Volpicelli G, Mussa A, Garofalo G, Cardinale L, Casoli G, Perotto F, Fava C, Frascisco M (2006) Bedside lung ultrasound in the assessment of alveolar–interstitial syndrome. Am J Emerg Med 24:689–696
    • View reference on publisher's website
    • View reference on PubMed
  3. Soldati G, Testa A, Silva FR, Carbone L, Portale G, Silveri NG (2006) Chest ultrasonography in lung contusion. Chest 130:533–538
    • View reference on publisher's website
    • View reference on PubMed
  4. Lichtenstein D, Mezière G (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 134:117–125
    • View reference on publisher's website
    • View reference on PubMed
  5. Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ (2004) Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasound in acute respiratory distress syndrome. Anesthesiology 100:9–15
    • View reference on publisher's website
    • View reference on PubMed
  6. Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri NG (2008) Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department. Chest 133:204–211
    • View reference on publisher's website
    • View reference on PubMed
  7. Soldati G (2006) Sonographic findings in pulmonary diseases. Radiol Med 111:507–515
    • View reference on publisher's website
    • View reference on PubMed
  8. Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le-Guen M, Girard M, Lu Q, Rouby JJ (2010) Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med 38:84–92
    • View reference on publisher's website
    • View reference on PubMed
  9. Juvet SC, Hwang D, Waddell TK, Downey GP (2008) Rare lung disease II: pulmonary alveolar proteinosis. Can Respir J 15:203–210
    • View reference on PubMed
  10. Rodi G, Iotti G, Galbusera C, Mencherini S, Raimondi F, Braschi A (1995) Whole lung lavage. Monaldi Arch Chest Dis 50:64–66
    • View reference on PubMed
  11. Soldati G, Copetti R, Sher S (2009) Sonographic interstitial syndrome: the sound of lung water. J Ultrasound Med 28:163–174
    • View reference on PubMed
  12. Agricola E, Bove T, Opizzi M (2005) “Ultrasound comet-tail images”: a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water. Chest 127:1690–1695
    • View reference on publisher's website
    • View reference on PubMed
  13. Reissig A, Kroegel C (2003) Transthoracic sonography of diffuse parenchymal lung disease: the role of comet tail artifacts. J Ultrasound Med 22:173–180
    • View reference on PubMed
  14. Lichtenstein DA, Lascols N, Mezière G, Gepner A (2004) Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med 30:276–281
  15. Reissig A, Kroegel C (2007) Sonographic diagnosis and follow up of pneumonia: a prospective study. Respiration 74:537–547
    • View reference on publisher's website
    • View reference on PubMed
  16. Copetti R, Soldati G, Copetti P (2008) Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound 6:16
    • View reference on publisher's website
    • View reference on PubMed
  17. Gargani L, Lionetti V, Di Cristofano C, Bevilacqua G, Recchia FA, Picano E (2007) Early detection of acute lung injury uncoupled to hypoxemia in pigs using ultrasound lung comets. Crit Care Med 35:2769–2774
    • View reference on publisher's website
    • View reference on PubMed
  18. Rajan GR (2007) Ultrasound lung comets: a clinically useful sign in acute respiratory distress syndrome/acute lung injury. Crit Care Med 35:2869–2870
    • View reference on publisher's website
    • View reference on PubMed
  19. Agricola E, Picano E, Oppizzi M, Pisani M, Meris A, Fragasso G, Margonato A (2006) Assessment of stress-induced pulmonary interstitial edema by chest ultrasound during exercise echocardiography and it correlation with left ventricular function. J Am Soc Echocardiogr 19:457–463
    • View reference on publisher's website
    • View reference on PubMed
  20. Gattinoni L, Pesenti A (2005) The concept of “baby lung”. Intensive Care Med 31:776–784
  21. Cohen E, Eisenkraft JB (1990) Bronchopulmonary lavage: effects on oxygenation and hemodynamics. J Cardiothorac Anesth 4:609–615
    • View reference on publisher's website
    • View reference on PubMed
  22. Puybasset L, Cluzel P, Chao N, Slutsky AS, Coriat P, Rouby JJ, The CT scan ARDS Study Group (1998) A computed tomography scan assessment of regional lung volume in acute lung injury. Am J Resp Crit Care Med 158:1644–1655
    • View reference on PubMed
  23. Patroniti N, Saini M, Zanella A, Weismann D, Isgrò S, Bellani G, Foti G, Pesenti A (2008) Measurement of end-expiratory lung volume by oxygen washin-washout in controlled and assisted mechanically ventilated patients. Intensive Care Med 34:2235–2240

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement