Regional pleural strain measurements during mechanical ventilation using ultrasound elastography: A randomised, crossover, proof of concept physiologic study

Abstract

Background Mechanical ventilation is a common therapy in operating rooms and intensive care units. When ill-adapted, it can lead to ventilator-induced lung injury (VILI), which is associated with poor outcomes. Excessive regional pulmonary strain is thought to be a major mechanism responsible for VILI. Scarce bedside methods exist to measure regional pulmonary strain. We propose a novel way to measure regional pleural strain using ultrasound elastography. Research Question The objective of this study was to assess the feasibility and reliability of pleural strain measurement by ultrasound elastography and to determine if elastography parameters would correlate with varying tidal volumes. Study Design and Methods A single-blind randomized crossover proof of concept study was conducted July to October 2017 at a tertiary care referral center. Ten patients requiring general anesthesia for elective surgery were recruited. After induction, patients were received tidal volumes of 6, 8, 10 and 12 mL.kg-1 in random order, while pleural ultrasound cineloops were acquired at 4 standardized locations. Ultrasound radiofrequency speckle tracking allowed computing various pleural translation, strain and shear components. These were screened to identify those with the best dose-response with tidal volumes using linear mixed effect models. Goodness-of-fit was assessed by the coefficient of determination. Intraobserver, interobserver and test-retest reliability were calculated using intraclass correlation coefficients. Results Analysis was possible in 90.7% of ultrasound cineloops. Lateral absolute shear, lateral absolute strain and Von Mises strain varied significantly with tidal volume and offered the best dose-responses and data modelling fits. Point estimates for intraobserver reliability measures were excellent for all 3 parameters (0.94, 0.94 and 0.93, respectively). Point estimates for interobserver (0.84, 0.83 and 0.77, respectively) and test-retest (0.85, 0.82 and 0.76, respectively) reliability measures were good. Interpretation Strain imaging is feasible and reproducible, and may eventually guide mechanical ventilation strategies in larger cohorts of patients.

Competing Interest Statement

Martin Girard is a paid consultant for the point-of-care ultrasonography group of GE Healthcare. Guy Cloutier has an active commercial license with Rheolution Inc. (Montreal, Canada) and a license option with Siemens Healthcare. Andre Y. Denault reports non-financial educational material support from CAE Healthcare, research equipment grants from Edwards and is on Masimo's speaker bureau. The other authors declare no competing interests.

Clinical Trial

NCT03092557

Funding Statement

Funding for the present work was secured through internal departmental funds.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The protocol was approved by the ethics committee of the Centre hospitalier de l'Universite de Montreal (16.386).

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Yes

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I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors.

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