4.5 Article

Progression of regional lung strain and heterogeneity in lung injury: assessing the evolution under spontaneous breathing and mechanical ventilation

Journal

ANNALS OF INTENSIVE CARE
Volume 10, Issue 1, Pages -

Publisher

SPRINGER
DOI: 10.1186/s13613-020-00725-0

Keywords

Acute lung injury; Spontaneous breathing; Mechanical ventilation; Lung strain; Lung heterogeneity; Image-based biomechanical analysis

Funding

  1. Millenium Science Initiative of the Ministry of Economy, Development and Tourism, grant Nucleus for Cardiovascular Magnetic Resonance
  2. Consejo Nacional de Desarrollo Cientifico y Tecnologico CONICYT Chile [Fondecyt Regular 1160631, Fondecyt Regular 1180832, FONDEF IDeA ID17I10301,]

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BackgroundProtective mechanical ventilation (MV) aims at limiting global lung deformation and has been associated with better clinical outcomes in acute respiratory distress syndrome (ARDS) patients. In ARDS lungs without MV support, the mechanisms and evolution of lung tissue deformation remain understudied. In this work, we quantify the progression and heterogeneity of regional strain in injured lungs under spontaneous breathing and under MV.MethodsLung injury was induced by lung lavage in murine subjects, followed by 3 h of spontaneous breathing (SB-group) or 3 h of low V-t mechanical ventilation (MV-group). Micro-CT images were acquired in all subjects at the beginning and at the end of the ventilation stage following induction of lung injury. Regional strain, strain progression and strain heterogeneity were computed from image-based biomechanical analysis. Three-dimensional regional strain maps were constructed, from which a region-of-interest (ROI) analysis was performed for the regional strain, the strain progression, and the strain heterogeneity.ResultsAfter 3 h of ventilation, regional strain levels were significantly higher in 43.7% of the ROIs in the SB-group. Significant increase in regional strain was found in 1.2% of the ROIs in the MV-group. Progression of regional strain was found in 100% of the ROIs in the SB-group, whereas the MV-group displayed strain progression in 1.2% of the ROIs. Progression in regional strain heterogeneity was found in 23.4% of the ROIs in the SB-group, while the MV-group resulted in 4.7% of the ROIs showing significant changes. Deformation progression is concurrent with an increase of non-aerated compartment in SB-group (from 13.3%1.6% to 37.5%+/- 3.1%), being higher in ventral regions of the lung.Conclusions p idPar Spontaneous breathing in lung injury promotes regional strain and strain heterogeneity progression. In contrast, low V-t MV prevents regional strain and heterogeneity progression in injured lungs.

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