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

Via, Gabriele; Lichtenstein, Daniel A.; Mojoli, Francesco; Rodi, Giuseppe; Neri, Luca; Storti, Enrico; Klersy, Catherine; Iotti, Giorgio; Braschi, A.

doi:10.1007/s00134-010-1834-4

Cited by 90 publications

(59 citation statements)

References 22 publications

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“…In patients with ARDS, the US study adequately estimates PEEP-induced lung recruitment compared with the pressure-volume curve method [4]. Furthermore, in patients undergoing whole lung lavage, US imaging clearly distinguishes the different states of aeration determined by alveolar flooding, (interstitial alveolar syndrome followed by consolidation), and reventilation (interstitial alveolar syndrome followed by normal pattern) [5].…”

Section: Discussionmentioning

confidence: 99%

Lung ultrasound in the reexpansion of pulmonary atelectasis

et al. 2011

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A 60-year-old man was admitted to our hospital complaining of dyspnea and productive cough that had been present for 24 h. One year prior, the patient had been diagnosed with amyotrophic lateral sclerosis. On admission, he was bedridden, had a tracheotomy, was ventilatordependent and fed by enteral nutrition by means of a gastrostomy tube.The vital signs were: blood pressure 120/80 mmHg, heart rate 110 beats/min, temperature 37°C. Percutaneous oxygen saturation was 85% on 80% ventilator-delivered oxygen. Physical examination revealed decreased breath sounds over the right lung and rales compatible with the presence of bronchial secretions over the left lung.A Chest x-ray study showed an opacification of the lower half of the right lung fields with mild homolateral mediastinal displacement suggesting pulmonary atelectasis ( Fig. 1). Electrocardiography was unremarkable. Blood gas analysis revealed hypocapnic respiratory failure. Other laboratory tests were normal except for a mild leucocytosis. The emergency physician performed a lung ultrasound (US), which confirmed the presence of a right pulmonary atelectasis appearing as an area of pulmonary parenchyma with a tissue-like pattern and abolished lung sliding in the presence of lung pulse (Fig. 2, Online Resource 1).In order to remove secretions, a bronchoscopy was performed while simultaneously checking for adequate pulmonary reexpansion with US imaging. As airway clearing progressed, the US study showed the appearance of an air bronchogram near the hilar pulmonary structures (Fig. 3, Online Resource 2), gradually advancing toward the peripheral parenchyma (Fig. 4, Online Resource 3) till pulmonary reexpansion was completed, as evidenced by the appearance of lung sliding and the disappearance of the tissue-like pattern (Fig. 5, Online Resource 4).After the procedure, the oxygen saturation was 95% on 40% ventilator-delivered oxygen. The physical examination revealed bilateral breath sounds. DiscussionPulmonary atelectasis is the loss of lung volume resulting from bronchial obstruction (obstructive atelectasis) or from parenchymal compression (nonobstructive atelectasis). Atelectasis produces a ventilation-perfusion mismatch, an intrapulmonary shunt, an increase in pulmonary vascular resistance and arterial hypoxemia. Furthermore, loss of aerated lung may increase the risk of pneumonia and ventilator-induced lung injury by overstretching of the aerated lung.US imaging study seems to be a useful tool for diagnosing and evaluating pulmonary atelectasis, and more Electronic supplementary material The online version of this article

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Section: Discussionmentioning

confidence: 99%

Lung ultrasound in the reexpansion of pulmonary atelectasis

et al. 2011

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“…22 By adding changes in ultrasound pattern detected in each region of interest, ultrasound scores or re-aeration have been proposed and correlated to reference methods for quantifying lung aeration changes (computed tomography, extravascular lung water, pulmonary wedge pressure, PV curves, lung lavage for alveolar proteinosis). 4,[22][23][24][25][26][27] Bedside transthoracic lung ultrasound has been demonstrated to be accurate for assessing re-aeration following fluid depletion in patients with hemodynamic pulmonary edema, PEEP-induced alveolar recruitment in ARDS, 4 lung re-aeration resulting from efficient antimicrobial therapy in patients with community-acquired 28 or ventilator-associated pneumonia, 22 and derecruitment observed at the early phase of acute lung injury 29 or during a spontaneous breathing trial. 30 Two different lung ultrasound scores have been proposed to assess lung recruitment and derecruitment induced by various treatments and lung diseases.…”

Section: Methods Based On Transthoracic Lung Ultrasoundmentioning

confidence: 99%

Measurement of Alveolar Recruitment at the Bedside: The Beginning of a New Era in Respiratory Monitoring?

et al. 2013

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“…Pulmonary congestion may be semiquantified using lung ultrasound [22,25,27,[51][52][53][54][55]. In the clinical arena, lung ultrasound can therefore be employed as a bedside, easy-to-use, alternative tool for monitoring pulmonary congestion changes in heart failure patients, as they disappear or clear upon adequate medical treatment [27,[56][57][58][59][60].…”

Section: P-d3-s2 (Strong: Level A)mentioning

confidence: 99%

International evidence-based recommendations for point-of-care lung ultrasound

et al. 2012

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Background: The purpose of this study is to provide evidence-based and expert consensus recommendations for lung ultrasound with focus on emergency and critical care settings. Methods: A multidisciplinary panel of 28 experts from eight countries was involved. Literature was reviewed from January 1966 to June 2011. Consensus members searched multiple databases including Pubmed, Medline, OVID, Embase, and others. The process used to develop these evidence-based recommendations involved two phases: determining the level of quality of evidence and developing the recommendation. The quality of evidence is assessed by the grading of recommendation, assessment, development, and evaluation (GRADE) method. However, the GRADE system does not enforce a specific method on how the panel should reach decisions during the consensus process. Our methodology committee decided to utilize the RAND appropriateness method for panel judgment and decisions/consensus. Results: Seventythree proposed statements were examined and discussed in three conferences held in Bologna, Pisa, and Rome. Each conference included two rounds of face-to-face modified Delphi technique. Anonymous panel voting followed each round. The panel did not reach an agreement and therefore did not adopt any recommendations for six statements. Weak/ conditional recommendations were made for 2 statements, and strong recommendations were made for the remaining 65 statements. The statements were then recategorized and grouped to their current format. Internal and external peer-review processes took place before submission of the recommendations. Updates will occur at least every 4 years or whenever significant major changes in evidence appear. Conclusions: This document reflects the overall results of the first consensus conference on ''point-of-care'' lung ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. Recommendations were produced to guide implementation, development, and standardization of lung ultrasound in all relevant settings.

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

Abstract: 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.

Cited by 90 publications

References 22 publications

Lung ultrasound in the reexpansion of pulmonary atelectasis

Lung ultrasound in the reexpansion of pulmonary atelectasis

Measurement of Alveolar Recruitment at the Bedside: The Beginning of a New Era in Respiratory Monitoring?

International evidence-based recommendations for point-of-care lung ultrasound

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