Pinezich Meghan R, Mir Seyed Mohammad, Reimer Jonathan A, Kaslow Sarah R, Chen Jiawen, Guenthart Brandon A, Bacchetta Matthew, O'Neill John D, Vunjak-Novakovic Gordana, Kim Jinho
Department of Biomedical Engineering Columbia University New York New York USA.
Department of Biomedical Engineering Stevens Institute of Technology Hoboken New Jersey USA.
Bioeng Transl Med. 2022 May 4;8(1):e10322. doi: 10.1002/btm2.10322. eCollection 2023 Jan.
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.
肺漏气是肺手术最常见的并发症，持续时间超过5天的漏气是术后发病的主要来源。由于精确定位和评估漏气的方法有限，漏气的临床管理具有挑战性。在此，我们提出一种声音引导方法，通过分析空气通过受损肺组织逸出时产生的独特声音，能够快速定量评估并精确定位漏气。肺手术后常因吻合钉线处或其附近组织完整性丧失而出现漏气。因此，我们在大鼠模型中研究了局灶性胸膜缺损产生的漏气声音，并在具有临床相关性的猪模型中研究了吻合钉线失效产生的漏气声音，以证明该方法的高灵敏度和转化潜力。在正压通气下，于距肺表面1厘米处放置胸膜内麦克风，建立大鼠和猪的自由流动型漏气模型，我们发现：（a）肺漏气产生的声音包含独特的谐波序列；（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）通过绘制肺表面声音响度水平图，可高分辨率（误差在1厘米内）确定漏气的精确位置。我们的研究结果表明，声音引导下的肺漏气评估和定位可作为一种诊断工具，为电视辅助胸腔镜手术（VATS）或开胸手术过程中的漏气检测和治疗策略提供依据。
