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Intensive Care Medicine

, Volume 36, Issue 6, pp 999–1007 | Cite as

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

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

Chest ultrasonography Lung, ultrasound diagnosis Extravascular lung water Pulmonary edema Whole lung lavage 

Abbreviations

LUS

Lung ultrasound

OLV

One-lung ventilation

PaO2/FiO2

Arterial oxygen tension/inspired oxygen fraction ratio

WLL

Whole lung lavage

Notes

Acknowledgments

We are very thankful to Dr. Gino Soldati for his valuable suggestions on developing the study, to Dr. Vincenzo Emmi for his encouraging comments and to Dr. Marco Garrone for language revision.

Supplementary material

134_2010_1834_MOESM1_ESM.doc (423 kb)
Supplementary material 1 (DOC 423 kb)

Supplementary Video 1 (MPG 460 kb)

Supplementary Video 2 (MPG 460 kb)

Supplementary Video 3 (MPG 678 kb)

Supplementary Video 4 (MPG 290 kb)

Supplementary Video 5 (MPG 206 kb)

Supplementary Video 6 (MPG 540 kb)

Supplementary Video 7 (MPG 317 kb)

Supplementary Video 8 (MPG 499 kb)

Supplementary Video 9 (MPG 290 kb)

Supplementary Video 10 (MPG 460 kb)

Supplementary Video 11 (MPG 238 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Gabriele Via
    • 1
  • Daniel Lichtenstein
    • 3
  • Francesco Mojoli
    • 1
  • Giuseppe Rodi
    • 1
  • Luca Neri
    • 4
  • Enrico Storti
    • 4
  • Catherine Klersy
    • 2
  • Giorgio Iotti
    • 5
  • Antonio Braschi
    • 1
  1. 1.1st Department of Anesthesia and Intensive Care, IRCCS Policlinico San Matteo FoundationUniversity of PaviaPaviaItaly
  2. 2.Service of Biometry and Clinical Epidemiology, Scientific Direction, IRCCS Policlinico San Matteo FoundationUniversity of PaviaPaviaItaly
  3. 3.Service de Réanimation Médicale, Hôpital AmbroiseBoulogne (Paris-Ouest)France
  4. 4.General ICUMilanItaly
  5. 5.2nd Department of Anesthesia and Intensive Care, IRCCS Policlinico San Matteo FoundationUniversity of PaviaPaviaItaly

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