Early detection of acute lung injury uncoupled to hypoxemia in pigs using ultrasound lung comets
Early detection of acute lung injury uncoupled to hypoxemia in pigs using ultrasound lung comets
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DOI：
10.1097/01.ccm.0000287525.03140.3f
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发表时间：
2007-12-01
影响因子：
8.8
通讯作者：
Picano, Eugenio
中科院分区：
文献类型：
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作者：
Gargani, Luna;Lionetti, Vincenzo;Picano, Eugenio
Objective.油酸诱导的肺损伤是一种已建立的猪急性肺损伤实验模型，被认为可重现急性呼吸窘迫综合征早期渗出相。超声肺彗星是血管外肺水的回声征象，起源于增厚的小叶间隔。本研究的目的是评估油酸诱导的猪肺损伤实验模型中超声肺彗星数、Pa 0（2）/F10（2）比值和静态呼吸顺应性之间的时间和关系。设计：实验室实验。设置：研究所。受试者：10只麻醉猪。干预措施：静脉注射油酸（0.1mL/kg）造成急性肺损伤。在基线和注射油酸后15、30、60和90分钟测量超声肺彗星、Pa 0（2）/F10（2）和静态呼吸顺应性。我们评估超声肺彗星经胸超声回波描记术（7.5 MHz血管探头），扫描在12个预定义的扫描situes.Measurements和主要结果：急性肺损伤/急性呼吸窘迫综合征是存在于所有猪在90分钟。超声肺彗星的数量随时间增加，并且始终早于Pa 0（2）/F10（2）的降低。15 min时，超声肺彗星明显增加，但Pa 0（2）/F10（2）无明显变化。因此，与基线相比，静态呼吸顺应性在15分钟时显著降低（17.04 +/- 1.82 vs. 34.84 +/- 2.62 mL/cm H2O，P < .05）。通过经胸回波描记术评估的超声肺彗星，在猪油酸肺损伤过程中的非常早期检测到血管外肺积水，在正常Pa 0（2）/F10（2）的情况下。这些结果表明，超声肺彗星可能是一种非常早期、无创且简单的方法来检测和量化急性肺损伤中的肺水肿。
Objective. Oleic acid-induced lung injury is an established experimental model of acute lung injury in pigs and is considered to reproduce the early exudative phase of acute respiratory distress syndrome. Ultrasound lung comets are an echographic sign of extravascular lung water, originating from thickened interlobular septa. The objective of this study was to evaluate the timing and relationship between the number of ultrasound lung comets, the Pa0(2)/F10(2) ratio, and the static respiratory compliance in an experimental model of oleic acid-induced lung injury in pigs.Design: Laboratory experiment.Setting: Research institute.Subjects: Ten anesthetized pigs.Interventions: Acute lung injury was induced by injection of oleic acid (0.1 mL/kg, intravenously). Ultrasound lung comets, Pa0(2)/F10(2), and static respiratory compliance were measured at baseline and at 15, 30, 60, and 90 mins after the injection of oleic acid. We evaluated ultrasound lung comets by transthoracic echography (7.5-MHz vascular probe), scanning on right and left hemithoraxes at 12 predefined scanning sites.Measurements and Main Results: Acute lung injury/acute respiratory distress syndrome was present in all pigs at 90 mins. The number of ultrasound lung comets increased over time and was consistently earlier than the decrease in Pa0(2)/F10(2). At 15 mins, ultrasound lung comets were markedly increased, but no significant changes in Pa0(2)/F10(2) were observed. Accordingly, static respiratory compliance was dramatically reduced at 15 mins compared with baseline (17.04 +/- 1.82 vs. 34.84 +/- 2.62 mL/cm H2O, P < .05).Conclusions: Ultrasound lung comets, assessed by transthoracic echography, detected extravascular lung water accumulation very early in the course of the oleic acid lung injury in pigs, in the presence of a normal Pa0(2)/F10(2). These results suggest that ultrasound lung comets could be a very early, noninvasive, and simple method to detect and quantify pulmonary edema in acute lung injury.