Quantitative lung ultrasound detects dynamic changes in lung recruitment in the preterm lamb

Arun Sett; Gillian W C Foo; Kelly R Kenna; Rebecca J Sutton; Elizabeth J Perkins; Magdy Sourial; Sheryle R Rogerson; Brett J Manley; Peter G Davis; Prue M Pereira-Fantini; David G Tingay

doi:10.1038/s41390-022-02316-0

Quantitative lung ultrasound detects dynamic changes in lung recruitment in the preterm lamb

Pediatr Res. 2023 May;93(6):1591-1598. doi: 10.1038/s41390-022-02316-0. Epub 2022 Sep 27.

Authors

Arun Sett^{1

2

3

4

5}, Gillian W C Foo⁶, Kelly R Kenna⁷, Rebecca J Sutton^{7

8}, Elizabeth J Perkins⁷, Magdy Sourial⁸, Sheryle R Rogerson^{6

9

10}, Brett J Manley^{7

6

9}, Peter G Davis^{7

6

9}, Prue M Pereira-Fantini^{7

6

11}, David G Tingay^{7

6

11

12}

Affiliations

¹ Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia. arun.sett@mcri.edu.au.
² Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia. arun.sett@mcri.edu.au.
³ Joan Kirner Women's and Children's Hospital, Western Health, St Albans, VIC, Australia. arun.sett@mcri.edu.au.
⁴ Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia. arun.sett@mcri.edu.au.
⁵ Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Parkville, VIC, Australia. arun.sett@mcri.edu.au.
⁶ Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia.
⁷ Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.
⁸ Translational Research Unit, Murdoch Children's Research Institute, Parkville, VIC, Australia.
⁹ Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia.
¹⁰ Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Parkville, VIC, Australia.
¹¹ Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
¹² Department of Neonatology, The Royal Children's Hospital, Parkville, VIC, Australia.

Abstract

Background: Lung ultrasound (LUS) may not detect small, dynamic changes in lung volume. Mean greyscale measurement using computer-assisted image analysis (Q-LUS_MGV) may improve the precision of these measurements.

Methods: Preterm lambs (n = 40) underwent LUS of the dependent or non-dependent lung during static pressure-volume curve mapping. Total and regional lung volumes were determined using the super-syringe technique and electrical impedance tomography. Q-LUS_MGV and gold standard measurements of lung volume were compared in 520 images.

Results: Dependent Q-LUS_MGV moderately correlated with total lung volume (rho = 0.60, 95% CI 0.51-0.67) and fairly with right whole (rho = 0.39, 0.27-0.49), central (rho = 0.38, 0.27-0.48), ventral (rho = 0.41, 0.31-0.51) and dorsal regional lung volumes (rho = 0.32, 0.21-0.43). Non-dependent Q-LUS_MGV moderately correlated with total lung volume (rho = 0.57, 0.48-0.65) and fairly with right whole (rho = 0.43, 0.32-0.52), central (rho = 0.46, 0.35-0.55), ventral (rho = 0.36, 0.25-0.47) and dorsal lung volumes (rho = 0.36, 0.25-0.47). All correlation coefficients were statistically significant. Distinct inflation and deflation limbs, and sonographic pulmonary hysteresis occurred in 95% of lambs. The greatest changes in Q-LUS_MGV occurred at the opening and closing pressures.

Conclusion: Q-LUS_MGV detected changes in total and regional lung volume and offers objective quantification of LUS images, and may improve bedside discrimination of real-time changes in lung volume.

Impact: Lung ultrasound (LUS) offers continuous, radiation-free imaging that may play a role in assessing lung recruitment but may not detect small changes in lung volume. Mean greyscale image analysis using computer-assisted quantitative LUS (Q-LUS_MGV) moderately correlated with changes in total and regional lung volume. Q-LUS_MGV identified opening and closing pressure and pulmonary hysteresis in 95% of lambs. Computer-assisted image analysis may enhance LUS estimation of lung recruitment at the bedside. Future research should focus on improving precision prior to clinical translation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Lung Volume Measurements / methods
Lung* / diagnostic imaging
Sheep
Tomography, X-Ray Computed*
Ultrasonography