DireCt Lung Ultrasound Evaluation (CLUE): A novel technique for monitoring extravascular lung water in donor lungs

Ayyat, K.S.; Okamoto, Toshihiro; Niikawa, Hiromichi; Itoda, Yoshifumi; Dugar, Siddharth; Latifi, Samir; Lebovitz, Daniel J.; Moghekar, Ajit; McCurry, Kenneth R.

doi:10.1016/j.healun.2019.03.005

Cited by 20 publications

(11 citation statements)

References 30 publications

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“…The increase of EVLW is the basic pathophysiological change in the early stage of lung injury. studies of isolated animal lungs and isolated human donor lungs indicated that LUSS 27 can accurately re ect the degree of extravascular lung water 28,29 , and more clinical evidence supported the application of lung ultrasound in critical diseases 30 .…”

Section: Discussionmentioning

confidence: 94%

“…The receiver operating characteristic (ROC) curves were graphed and area under the curve (AUC) were calculated to investigate the accuracy of indicators for predicting AKI, TIC within 48 hours, and 28-day mortality in trauma group. All statistical tests were two-tailed, and P < 0.05 was considered statistically signi cant.The trauma group had a median ISS of 24(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Main causes of trauma were tra c injuries and falling injuries (53.3% and 31.1%, respectively).…”

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confidence: 99%

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Endothelial Glycocalyx Degradation Is Associated With Early Organ Impairment in Multiple Trauma Patients

Zhou

et al. 2021

Preprint

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BackgroundEndothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. However, data of EG degradation in multiple traumas is limited. We performed a study to assess the EG degradation and the correlation between the degradation and organ functions in multiple trauma patients. MethodsA prospective observational study was conducted to enroll health participants (control group) and multiple traumas patients (trauma group) at a University affiliated hospital between Feb 2020 and Oct 2020. Syndecan1 (SDC1) and heparin sulfate (HS) were detected in serum sample of both groups. In trauma group, injury severity scores (ISS) and sequential organ failure assessments (SOFA) were calculated. Occurrences of acute kidney injury (AKI), trauma-induced coagulopathy (TIC) within 48 hours and 28-day all-cause mortality in trauma group were recorded. Serum SDC1 and HS levels were compared between two groups. Correlations between SDC1/HS and the indicators of organ systems in the trauma group were analyzed. ROC analyses were performed to assess the predictive value of SDC1 and HS for AKI, TIC within 48 hours, and 28-day mortality in trauma group. ResultsThere were 45 multiple trauma patients and 15 healthy participants were collected, totally. SDC1 and HS were significantly higher in trauma group than in control group (69.39 [54.18–130.80] vs. 24.15 [13.89–32.36], 38.92 [30.47–67.96] vs. 15.55 [11.89–23.24], P<0.001, respectively). SDC1 and HS were both positively correlated with prothrombin time, activated partial thromboplastin time, EVLW, N-terminal pro-B-type natriuretic peptide, myoglobin, creatinine, lactic acid, interleukin-6, and tumor necrosis factor-α (P<0.05, respectively). SDC1 and HS were both negatively correlated with Ca2+, anti-thrombin-III, PaO2/FiO2 ratio, pH and albumin (P<0.05, respectively). Trauma group was divided into high degradation group and low degradation group according to SDC1 median. High degradation group had more severe ISS, SOFA scores, worse organ functions (respiratory, kidney, coagulation and metabolic system), and higher incidence of hypothermia, acidosis and shock. ROC curve analyses demonstrated SDC1 can predict the occurrence risk of AKI, TIC within 48h, and 28-day mortality. ConclusionsEG degradation was elevated significantly in multiple trauma patients, and the degradation was correlated with impaired respiratory, kidney, coagulation and metabolic systems. Serum SDC1 is a valuable predictive indicator of early TIC, AKI risk, and 28-day mortality in multiple trauma patients.

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Endothelial Glycocalyx Degradation Is Associated With Early Organ Impairment in Multiple Trauma Patients

Zhou

et al. 2021

Preprint

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“…Most existing methods do not provide continuous measurement but rather hourly measurements with specific procedures, such as transpulmonary thermodilution, ultrasound, and chest computed tomography. 7-9,26 Therefore, we believe that real-time lung weight measurements may further improve preclinical experiments and clinical case management.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, we demonstrated a non-invasive diagnostic tool to monitor EVLW using direct lung ultrasound evaluation. 8 , 9 Recently, Sakanoue et al 10 reported the use of real-time lung weight measurements to detect EVLW in clinical acellular EVLP. The study showed that the lung weight gain at 10 to 60 min can be a reliable predictive parameter of transplant suitability.…”

Section: Introductionmentioning

confidence: 99%

Real-time Lung Weight Measurement During Cellular Ex Vivo Lung Perfusion: An Early Predictor of Transplant Suitability

et al. 2023

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Background. Increased extravascular lung water during ex vivo lung perfusion (EVLP) is associated with ischemia reperfusion injury and poor pulmonary function. A non-invasive technique for evaluating extravascular lung water during EVLP is desired to assess the transplant suitability of lungs. We investigated real-time lung weight measurements as a reliable method for assessing pulmonary functions in cellular EVLP using a porcine lung model. Methods. Fifteen pigs were randomly divided into 3 groups: control (no warm ischemia) or donation after circulatory death groups with 60 or 90 min of warm ischemia (n = 5, each). Real-time lung weight gain was measured by load cells positioned at the bottom of the organ chamber. Results. Real-time lung weight gain at 2 h was significantly correlated with lung weight gain as measured on a back table (R = 0.979, P < 0.01). Lung weight gain in non-suitable cases (n = 6) was significantly higher than in suitable cases (n = 9) at 40 min (51.6 ± 46.0 versus −8.8 ± 25.7 g; P < 0.01, cutoff = +12 g, area under the curve = 0.907). Lung weight gain at 40 min was significantly correlated with PaO 2 /FiO 2 , peak inspiratory pressure, shunt ratio, wet/dry ratio, and transplant suitability at 2 h (P < 0.05, each). In non-suitable cases, lung weight gain at 66% and 100% of cardiac output was significantly higher than at 33% (P < 0.05). Conclusions. Real-time lung weight measurement could potentially be an early predictor of pulmonary function in cellular EVLP.

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“…The CLUE score is correlated to the weight of the EVLP lungs, which correlated negatively with PaO 2 /FiO 2 ratio. 26 Biochemical markers may also be important in the assessment of EVLP lungs. After inducing cardiac death in a swine model and waiting an hour at room temperature, Sanchez and colleagues procured lungs and placed them on EVLP.…”

Section: Current and Future Modes Of Assessment Of Lungs On Evlpmentioning

confidence: 99%

Ex Vivo Lung Perfusion: A Review of Research and Clinical Practices

Chan

Kumar

Subramaniam

et al. 2020

Semin Cardiothorac Vasc Anesth

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End-stage lung disease is ultimately treated with lung transplantation. However, there is a paucity of organs with an increasing number of patients being diagnosed with end-stage lung disease. Ex vivo lung perfusion has emerged as a potential tool to assess the quality and to recondition marginal donor lungs prior to transplantation with the goal of increasing the donor pool. This technology has shown promise with similar results compared with the conventional technique of cold static preservation in terms of primary graft dysfunction and overall outcomes. This review provides an update on the results and uses of this technology. The review will also summarize clinical studies and techniques in reconditioning and assessing lungs on ex vivo lung perfusion. Last, we discuss how this technology can be applied to fields outside of transplantation such as thoracic oncology and bioengineering.

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DireCt Lung Ultrasound Evaluation (CLUE): A novel technique for monitoring extravascular lung water in donor lungs

Cited by 20 publications

References 30 publications

Endothelial Glycocalyx Degradation Is Associated With Early Organ Impairment in Multiple Trauma Patients

Endothelial Glycocalyx Degradation Is Associated With Early Organ Impairment in Multiple Trauma Patients

Real-time Lung Weight Measurement During Cellular Ex Vivo Lung Perfusion: An Early Predictor of Transplant Suitability

Ex Vivo Lung Perfusion: A Review of Research and Clinical Practices

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