Sound-guided assessment and localization of pulmonary air leak.
Sound-guided assessment and localization of pulmonary air leak.
复制标题
DOI：
10.1002/btm2.10322
复制
发表时间：
2023-01
影响因子：
7.4
通讯作者：
中科院分区：
文献类型：
--
作者：
肺漏气是肺部手术最常见的并发症，漏气持续时间超过 5 天是术后发病的主要来源。由于精确定位和评估泄漏的方法有限，漏气的临床管理具有挑战性。在这里，我们提出了一种声音引导方法，通过分析空气通过有缺陷的肺组织逸出时产生的不同声音，可以快速定量评估和精确定位空气泄漏。由于钉线处或附近组织完整性的丧失，肺部手术后经常出现漏气。因此，我们研究了大鼠模型中局灶性胸膜缺损和临床相关猪模型中钉线故障的漏气声音，以证明该方法的高灵敏度和转化潜力。在距离肺表面 1 厘米的胸膜内麦克风进行正压通气下自由流动漏气的大鼠和猪模型中，我们发现：(a) 肺漏气产生包含不同谐波系列的声音，(b) 漏气声音的声学特征可用于对漏气严重程度进行分类，(c) 通过绘制整个肺表面的声音响度水平，可以以高分辨率（1 厘米内）确定漏气的精确位置。我们的研究结果表明，声音引导的肺部漏气评估和定位可以作为诊断工具，为视频辅助胸腔镜手术（VATS）或开胸手术期间的漏气检测和治疗策略提供信息。
Pulmonary air leak is the most common complication of lung surgery, with air leaks that persist longer than 5 days representing a major source of post‐surgery morbidity. Clinical management of air leaks is challenging due to limited methods to precisely locate and assess leaks. Here, we present a sound‐guided methodology that enables rapid quantitative assessment and precise localization of air leaks by analyzing the distinct sounds generated as the air escapes through defective lung tissue. Air leaks often present after lung surgery due to loss of tissue integrity at or near a staple line. Accordingly, we investigated air leak sounds from a focal pleural defect in a rat model and from a staple line failure in a clinically relevant swine model to demonstrate the high sensitivity and translational potential of this approach. In rat and swine models of free‐flowing air leak under positive pressure ventilation with intrapleural microphone 1 cm from the lung surface, we identified that: (a) pulmonary air leaks generate sounds that contain distinct harmonic series, (b) acoustic characteristics of air leak sounds can be used to classify leak severity, and (c) precise location of the air leak can be determined with high resolution (within 1 cm) by mapping the sound loudness level across the lung surface. Our findings suggest that sound‐guided assessment and localization of pulmonary air leaks could serve as a diagnostic tool to inform air leak detection and treatment strategies during video‐assisted thoracoscopic surgery (VATS) or thoracotomy procedures.