Ultrasound for “Lung Monitoring” of Ventilated Patients

Bouhemad, Bélaïd; Mongodi, Silvia; Via, Gabriele; Rouquette, Isabelle

doi:10.1097/aln.0000000000000558

Cited by 253 publications

(249 citation statements)

References 41 publications

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“…The ultrasound pattern corresponds to the degree of lung aeration. 88,[93][94][95][96] This allows the potential for the use of ultrasound to monitor the response to recruitment maneuvers and PEEP titration (Fig. 9).…”

Section: Imagingmentioning

confidence: 99%

Recruitment Maneuvers and PEEP Titration

2015

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The injurious effects of alveolar overdistention are well accepted, and there is little debate regarding the importance of pressure and volume limitation during mechanical ventilation. The role of recruitment maneuvers is more controversial. Alveolar recruitment is desirable if it can be achieved, but the potential for recruitment is variable among patients with ARDS. A stepwise recruitment maneuver, similar to an incremental PEEP titration, is favored over sustained inflation recruitment maneuvers. Many approaches to PEEP titration have been proposed, and the best method to choose the most appropriate level for an individual patient is unclear. A PEEP level should be selected that balances alveolar recruitment against overdistention. The easiest approach to select PEEP might be according to the severity of the disease: 5-10 cm H 2 O PEEP in mild ARDS, 10 -15 cm H 2 O PEEP in moderate ARDS, and 15-20 cm H 2 O PEEP in severe ARDS. Recruitment maneuvers and PEEP should be used within the context of lung protection and not just as a means of improving oxygenation.

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Section: Imagingmentioning

confidence: 99%

Recruitment Maneuvers and PEEP Titration

2015

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“…33 A complete description of the lung aeration score is beyond the scope of this review as it was validated only with transthoracic imaging. We refer the interested reader to the excellent review by Bouhemad et al 30 Cardiogenic pulmonary edema can also be responsible for unsuccessful weaning. During the transition from positive pressure ventilation to spontaneous unassisted breathing, left ventricular diastolic dysfunction may be unmasked by increased venous return, 34 and systolic dysfunction may be unmasked by increased left ventricular afterload.…”

Section: Integrated Cardiopulmonary Approach To Hypoxemia and Other Cmentioning

confidence: 99%

“…This approach allows access to the posterosuperior zones, considered the blind spots of transthoracic ultrasonography created by the scapulae. 30 The main limitation of TELU is that it has not yet been sufficiently validated. It is more invasive than transthoracic ultrasonography and has significantly less supporting evidence.…”

Section: Advantages and Limitationsmentioning

confidence: 99%

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Transesophageal lung ultrasonography: a novel technique for investigating hypoxemia

Cavayas

Girard

Desjardins

et al. 2016

Can J Anesth/J Can Anesth

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Background Acute deterioration in respiratory status commonly occurs in patients who cannot be transported for imaging studies, particularly during surgical procedures and in critical care settings. Transthoracic lung ultrasonography has been developed to allow rapid diagnosis of respiratory conditions at the bedside. Nevertheless, the thorax is not always accessible, especially in the perioperative setting. Transesophageal lung ultrasonography (TELU) can be used to circumvent this problem. Purpose The aim of this narrative review is to provide a complete description of the TELU technique by summarizing the existing literature on the subject and describing our own experience that extrapolates from transthoracic lung ultrasonography. Principal findings The use of TELU can provide point-ofcare real-time information for quickly establishing the etiology of acute hypoxemia. The transesophageal probe is placed in close proximity to the posterior regions of the lungs where lung consolidation and pleural effusions are most often seen; however, most of the artefacts relied on by transthoracic ultrasound have yet to be validated with TELU. Moreover, the relative invasiveness of TELU compared with transthoracic ultrasonography may limit its use to specific situations when the probe is already in place, as during cardiac anesthesia or when the anterior thorax is inaccessible. The main advantage of TELU may lie in the ability to integrate both cardiac and pulmonary assessments in one single examination. Conclusion Anesthesiologists and intensivists who already use transesophageal echocardiography on a regular basis should consider adding TELU to their clinical assessment of hypoxemia and related pulmonary pathologies. Nevertheless, the literature specifically supporting TELU is relatively limited, and further validation studies are needed. RésuméContexte Des détériorations aiguës de l'état respiratoire de patients qui ne peuvent être transportés pour des examens d'imagerie sont fréquentes, particulièrement lors d'interventions chirurgicales ainsi que dans le contexte des soins intensifs. L'échographie pulmonaire transthoracique a été mise au point afin de permettre de diagnostiquer rapidement la cause d'une détérioration respiratoire au chevet du patient. Or, le thorax n'est pas toujours accessible, particulièrement dans un contexte périopératoire.L'échographie transoesophagienne pulmonaire (ETOP) peut alors être utilisée pour pallier ce problème.

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“…The loss of aeration and its regional distribution can be estimated with LUS (33,41) through the attribution of numeric values at each LUS pattern. Thereafter, various algorithms have been created to use LUS as a tool for the respiratory monitoring and diagnostic of critically ill patients (42). Score-based LUS can assess aeration or changes in aeration semi-quantitatively in different thoracic districts, allowing a better understanding of the lung morphology and the distribution of focal or diffuse aeration loss in the early phases of ARDS (41).…”

Section: Lusmentioning

confidence: 99%

Lung imaging: how to get better look inside the lung

Ball¹,

Vercesi²,

Costantino³

et al. 2017

Ann. Transl. Med.

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In the last years, imaging has played a key role in the diagnosis and monitoring and critical illness, including acute respiratory distress syndrome (ARDS). Chest X-ray (CXR) and computed tomography (CT) are the conventional techniques most performed in the critically ill patients, the latter being the gold standard to assess lung aeration in ARDS patients. In addition, two bedside techniques are now gaining popularity alongside the conventional ones: lung ultrasound (LUS) and electrical impedance tomography (EIT). These techniques do not involve the use of ionizing radiations, are non-invasive and relatively easy to use, and are under extensive investigation as a complement, and for some application a substitution of conventional techniques. At last, positron emission tomography (PET) and magnetic resonance imaging (MRI) can provide functional information on the lung and respiratory function, and are increasingly used in research to improve the understanding of the pathophysiological mechanisms underlying ARDS. The purpose of this review is to give an up-to-date overview of the conventional and emerging imaging techniques available the diagnosis and management of patients with ARDS.

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Ultrasound for “Lung Monitoring” of Ventilated Patients

Cited by 253 publications

References 41 publications

Recruitment Maneuvers and PEEP Titration

Recruitment Maneuvers and PEEP Titration

Transesophageal lung ultrasonography: a novel technique for investigating hypoxemia

Lung imaging: how to get better look inside the lung

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