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. 2022 Jul 1;50(7):e630-e637.
doi: 10.1097/CCM.0000000000005479. Epub 2022 Feb 8.

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

Irene Steinberg  1 , Iacopo Pasticci  1 , Mattia Busana  1 , Andrea Costamagna  2 , Günter Hahn  1 , Simone Gattarello  1   3 , Paola Palermo  1   3 , Stefano Lazzari  1   3 , Federica Romitti  1 , Peter Herrmann  1 , Onnen Moerer  1 , Leif Saager  1 , Konrad Meissner  1 , Michael Quintel  1   4 , Luciano Gattinoni  1
Affiliations

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

Irene Steinberg et al. Crit Care Med. .

Abstract

Objectives: 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).

Design: Experimental animal study.

Setting: Experimental Department of a University Hospital.

Subjects: Forty-two female pigs (24.2 ± 2.0 kg).

Interventions: 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).

Measurements and main results: 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).

Conclusions: 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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Conflict of interest statement

Dr. Gattinoni reports to be a consultant for General Electrics and SIDAM (Mirandola, Modena, Italy). He also receives lectures fees from Estor and Dimar. He received support for article research from departmental sources and Sartorius AG (Otto-BrennerStraße 20, 37079, Göttingen, Germany). Dr. Saager reports financial relationships with Medtronic, Ferrer Deutschland, and Merck. Part of the salary support for the author Dr. Busana was provided by an unrestricted research grant from Sartorius, Göttingen, Germany. Dr. Lazzari disclosed work for hire. Dr. Moerer’s institution received funding from the National CEOsys Network Germany, funded by the Federal Ministry of Education and Research (FKZ 01KX2021) and an unrestricted grant from CSL Behring and Pulsion Medical Systems SE; he received funding from Pulsion Medial Systems SE and CSL Behring. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

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