Buttar Sana N, Møller-Sørensen Hasse, Perch Michael, Petersen Rene H, Møller Christian H
Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Eur J Cardiothorac Surg. 2024 Dec 26;67(1). doi: 10.1093/ejcts/ezae428.
Extravascular lung water precedes deterioration of pulmonary function. Current tools to assess extravascular lung water in a setting of donor lung procurement and ex vivo lung perfusion (EVLP) are either subjective or not feasible. Therefore, a direCt Lung Ultrasound Evaluation (CLUE) has been introduced. This study reassesses the feasibility and accuracy of CLUE by measuring its correlation with lung weight, wet-to-dry ratio (W/D ratio), dynamic compliance and pulmonary vascular resistance (PVR) in a porcine model.
CLUE images, lung weight, dynamic compliance and PVR were recorded and lung samples for W/D ratio were taken before and after EVLP. CLUE score was calculated based on B-lines on images taken at each point of the lung using an established equation.
Eighteen porcine lungs were included. Total median of CLUE score, lung weight, W/D ratio and PVR increased significantly, while median of dynamic compliance decreased significantly after EVLP. Total median CLUE score increased significantly in all four surfaces after EVLP with equally high CLUE scores in posterior and diaphragm lines. CLUE score demonstrated a significant strong positive correlation with lung weight (r = 0.825) and W/D ratio (r = 0.837), while CLUE's correlation with dynamic compliance and PVR was significantly moderate to strong (r = -0.669, r = 0.695, respectively).
CLUE technique is feasible to assess extravascular lung water in donor lungs after procurement and during EVLP. CLUE score correlated significantly with lung weight, W/D ratio, dynamic compliance and PVR. Transplant suitability of a donor lung may not solely depend on CLUE evaluation.
血管外肺水在肺功能恶化之前出现。目前在供体肺获取和体外肺灌注（EVLP）过程中评估血管外肺水的工具要么主观，要么不可行。因此，引入了直接肺超声评估（CLUE）。本研究通过在猪模型中测量CLUE与肺重量、湿干比（W/D比）、动态顺应性和肺血管阻力（PVR）的相关性，重新评估CLUE的可行性和准确性。
记录CLUE图像、肺重量、动态顺应性和PVR，并在EVLP前后采集肺样本用于测定W/D比。使用既定方程根据在肺的每个点拍摄的图像上的B线计算CLUE评分。
纳入18个猪肺。EVLP后，CLUE评分、肺重量、W/D比和PVR的总中位数显著增加，而动态顺应性的中位数显著降低。EVLP后，所有四个表面的CLUE评分总中位数均显著增加，后线和膈肌线的CLUE评分同样高。CLUE评分与肺重量（r = 0.825）和W/D比（r = 0.837）呈显著强正相关，而CLUE与动态顺应性和PVR的相关性显著中等至强（分别为r = -0.669，r = 0.695）。
CLUE技术在供体肺获取后和EVLP期间评估血管外肺水是可行的。CLUE评分与肺重量、W/D比、动态顺应性和PVR显著相关。供体肺的移植适用性可能不完全取决于CLUE评估。
