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Lung ultrasound predicts histological lung injury in a neonatal model of acute respiratory distress syndrome
Author(s) -
Elsayed Yasser N.,
Hinton Martha,
Graham Ruth,
Dakshinamurti Shyamala
Publication year - 2020
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.24993
Subject(s) - medicine , ards , lung , mean airway pressure , diffuse alveolar damage , pulmonary edema , anesthesia , fraction of inspired oxygen , hypoxemia , respiratory distress , mechanical ventilation , cardiology , acute respiratory distress
Rationale Point‐of‐care ultrasound (POCUS) is used to evaluate pulmonary edema in adults with acute respiratory distress syndrome (ARDS). Its use has not been validated in neonatal models. Objectives We compared an in vivo lung ultrasound score against clinical and histological markers of acute lung injury, in a neonatal animal model, hypothesizing that POCUS would sensitively diagnose early acute lung injury in neonates and discern its severity. Methods Fifteen anesthetized, ventilated 3‐day‐old neonatal piglets were divided into controls, moderate lung injury, or severe lung injury by graded treatment with oleic acid. Degree of lung injury was quantified at baseline, immediately after oleic acid administration, and 1 hour after the evolution of acute lung injury, by blood gases, ventilation parameters and calculated oxygenation deficit; hemodynamic indices by echocardiography, and lung ultrasound obtained in an 8‐region grid of anterior and posterior zones, semi‐quantitatively analyzed by a blinded observer. Lungs were inflation‐fixed postmortem at last mean airway pressure, for histological assessment. Results Acute lung injury manifested in oleic acid‐treated groups as dose‐dependent capillary leak causing intravascular depletion and cardiac failure, hypoxemia with increasing intrapulmonary shunt fraction, decreased lung compliance, and resistance. Ultrasound scores of anterior regions distinguished moderate from severe injury; scores in posterior regions reached maximum values immediately after lung injury. POCUS score correlated with calculated intrapulmonary shunt fraction ( R 2 = .65) and with histological injury score ( R 2 = .61), P < .01. Conclusion We conclude that POCUS may be valuable in neonates for early quantification of acute lung injury or ARDS; and that nondependent ultrasound regions clearly distinguish severity of pulmonary edema.