DireCt Lung Ultrasound Evaluation (CLUE): A novel technique for monitoring extravascular lung water in donor lungs.,The Journal of Heart and Lung Transplantation

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DireCt Lung Ultrasound Evaluation (CLUE): A novel technique for monitoring extravascular lung water in donor lungs.
The Journal of Heart and Lung Transplantation ( IF 8.9 ) Pub Date : 2019-03-13 , DOI: 10.1016/j.healun.2019.03.005
Kamal S Ayyat ₁ , Toshihiro Okamoto ₂ , Hiromichi Niikawa ₃ , Yoshifumi Itoda ₃ , Siddharth Dugar ₄ , Samir Q Latifi ₅ , Daniel J Lebovitz ₆ , Ajit Moghekar ₄ , Kenneth R McCurry ₂

Affiliation

BACKGROUND

Extravascular lung water (EVLW) could change in donor lungs in a time-dependent fashion during procurement or ex-vivo lung perfusion (EVLP) and may vary across different zones. Current techniques for EVLW assessment are either subjective, general estimation, or not feasible in the clinical setting. An accurate and non-invasive diagnostic tool for EVLW would be desirable for donor lung assessment and management. Therefore, we studied the feasibility and accuracy of direCt Lung Ultrasound Evaluation (CLUE) technique.

METHODS

Eleven lungs were utilized for the human model and 6 lungs for the porcine model. Lungs underwent EVLP for 2 hours. In CLUE, ultrasound images were taken directly from the lungs. A scoring system was created for each point based on the percentage of B-lines. Images were graded according to the degree of edema. An equation was used to calculate total lung and lobe scores based on number of images of each grade.

RESULTS

CLUE point score correlated with wet/dry ratio in human and porcine models (n = 99, r = 0.863, p < 0.001; and n = 31, r = 0.916, p < 0.001, respectively). CLUE total lung score correlated with lung weight (n = 19, r = 0.812, p < 0.001; and n = 12, r = 0.895, p < 0.001, respectively). CLUE lobe score correlated negatively with partial pressure of oxygen/fraction of inspired oxygen ratio in the human model (n = 20, r = −0.775, p < 0.001).

CONCLUSIONS

EVLW monitoring in donor lungs with CLUE after procurement is feasible and CLUE scores were found to be significantly correlated with lung weight, wet/dry, and PaO₂/FIO₂ ratio.

中文翻译：

DireCt肺部超声评估（CLUE）：一种监测供体肺中血管外肺水的新技术。

背景

在采购或离体肺灌注（EVLP）期间，血管外肺水（EVLW）可能以时间依赖性方式改变供体肺，并且在不同区域可能有所不同。当前用于EVLW评估的技术要么是主观的，一般的估计，要么在临床环境中不可行。对于供体肺评估和管理，需要一种用于EVLW的准确且无创的诊断工具。因此，我们研究的可行性和悲惨的准确性Ç吨大号UNG ù ltrasound ë估价（CLUE）技术。

方法

人体模型使用了11个肺部，猪模型使用了6个肺部。肺接受EVLP治疗2小时。在CLUE中，直接从肺部获取超声图像。根据B线的百分比为每个点创建一个评分系统。根据水肿程度对图像进行分级。基于每个等级的图像数量，使用一个方程式来计算总的肺和肺叶得分。

结果

在人和猪模型中，CLUE点得分与干/湿比相关（分别为n  = 99，r  = 0.863，p <0.001；n  = 31，r  = 0.916，p <0.001）。CLUE肺总评分与肺重量相关（分别为n  = 19，r  = 0.812，p <0.001；n  = 12，r  = 0.895，p <0.001）。在人体模型中，CLUE瓣分数与氧气分压/吸入氧气比率的分数呈负相关（n  = 20，r  = -0.775，p <0.001）。