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

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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.

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Abbreviations

LUS:

Lung ultrasound

OLV:

One-lung ventilation

PaO2/FiO2 :

Arterial oxygen tension/inspired oxygen fraction ratio

WLL:

Whole lung lavage

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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.

Author information

Correspondence to Gabriele Via.

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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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Via, G., Lichtenstein, D., Mojoli, F. et al. Whole lung lavage: a unique model for ultrasound assessment of lung aeration changes. Intensive Care Med 36, 999–1007 (2010). https://doi.org/10.1007/s00134-010-1834-4

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Keywords

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