AI Article Synopsis
- Transthoracic lung ultrasound is being studied as a way to detect pulmonary hyperdistention, which can occur during mechanical ventilation and is usually not detected by standard assessments.
- Eighteen patients with normal lungs were monitored during lower abdominal surgery while various levels of positive-end expiratory pressure (PEEP) were applied, and ultrasound data were compared to electrical impedance tomography findings.
- Results showed that an increase in the number of horizontal A lines in lung ultrasound correlated with decreasing intercostal space thickness, with six A lines identified as the threshold indicating hyperdistention, demonstrating the ultrasound's potential for clinical use in monitoring lung conditions during surgery.
Article Abstract
Introduction: Transthoracic lung ultrasound can assess atelectasis reversal and is considered as unable to detect associated hyperdistention. In this study, we describe an ultrasound pattern highly suggestive of pulmonary hyperdistention.
Methods: Eighteen patients with normal lungs undergoing lower abdominal surgery were studied. Electrical impedance tomography was calibrated, followed by anaesthetic induction, intubation and mechanical ventilation. To reverse posterior atelectasis, a recruitment manoeuvre was performed. Positive-end expiratory pressure (PEEP) titration was then obtained during a descending trial - 20, 18, 16, 14, 12, 10, 8, 6 and 4cmHO. Ultrasound and electrical impedance tomography data were collected at each PEEP level and interpreted by two independent observers. Spearman correlation test and receiving operating characteristic curve were used to compare lung ultrasound and electrical impedance tomography data.
Results: The number of horizontal A lines increased linearly with PEEP: from 3 (0, 5) at PEEP 4cmHO to 10 (8, 13) at PEEP 20cmHO. The increase number of A lines was associated with a parallel and significant decrease in intercostal space thickness (p=0.001). The lung ultrasound threshold for detecting pulmonary hyperdistention was defined as the number of A lines counted at the PEEP preceding the PEEP providing the best respiratory compliance. Six A lines was the median threshold for detecting pulmonary hyperdistention. The area under the receiving operating characteristic curve was 0.947.
Conclusions: Intraoperative transthoracic lung ultrasound can detect lung hyperdistention during a PEEP descending trial. Six or more A lines detected in normally aerated regions can be considered as indicating lung hyperdistention.
Trial Registration: NCT02314845 Registered on ClinicalTrials.gov.
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| http://dx.doi.org/10.1016/j.accpm.2020.09.009 | DOI Listing |
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