Gabriele Via Daniel Lichtenstein Francesco Mojoli Giuseppe Rodi Luca Neri Enrico Storti Catherine Klersy Giorgio Iotti Antonio Braschi Whole lung lavage: a unique model for ultrasound assessment of lung aeration changes Received: 27 November 2008 Accepted: 6 December 2009 Published online: 11 March 2010 Ó Copyright jointly held by Springer and ESICM 2010 Electronic supplementary material The online version of this article (doi:10.1007/s00134-010-1834-4) contains supplementary material, which is available to authorized users. G. Via ( ) ) Á F. Mojoli Á G. Rodi Á A. Braschi 1st Department of Anesthesia and Intensive Care, IRCCS Policlinico San Matteo Foundation, University of Pavia, Piazzale Golgi 2, 27100 Pavia, Italy e-mail: gcvia@libero.it Tel.: ?39-0382-503711; ?39-0382-503501 C. Klersy Service of Biometry and Clinical Epidemiology, Scientific Direction, IRCCS Policlinico San Matteo Foundation, University of Pavia, Piazzale Golgi 2, 27100 Pavia, Italy D. Lichtenstein Service de Re ´animation Me ´dicale, Ho ˆpital Ambroise, Pare ´, 92100 Boulogne (Paris-Ouest), France L. Neri Á E. Storti General ICU, Azienda Ospedaliera Niguarda Ca’ Granda, 20162 Milan, Italy G. Iotti 2nd Department of Anesthesia and Intensive Care, IRCCS Policlinico San Matteo Foundation, University of Pavia, Piazzale Golgi 2, 27100 Pavia, Italy Abstract Purpose: Whole lung lavage (WLL) pathophysiologically represents a human model of con- trolled lung de-aeration, resembling various pathological conditions encountered in the critically ill. Through one-lung ventilation and progressive alveolar flooding, it mimics, respectively, re-absorption atelectasis formation and lung con- solidation. With re-ventilation of the treated lung, PEEP application and diuretics administration, it then cre- ates a model of pulmonary edema and its progressive resolution. No studies have so far described lung aeration changes during WLL with ultrasound: objectives of the study were to describe ultrasound findings during WLL with validated semiotics in the critically ill and to investigate their relation with the lung’s state of rela- tive aeration. Methods: In seven patients, 12 lung areas/patient were prospectively studied with ultrasound during six procedural steps of WLL. A three-tiered pattern classification was assigned (1, normal/nearly nor- mal; 2, alveolar-interstitial syndrome; 3, alveolar consolidation) consistently with their previously described meaning in terms of relative air con- tent. The distribution was compared throughout different WLL maneuvers as it was for arterial oxygen measurement distribution. Results: During one-lung ventila- tion and saline flooding, ultrasound findings shifted from artifact patterns (normal/nearly normal and alveolar- interstitial syndrome) to alveolar consolidation. Saline removal, re-ventilation and negative water balance were associated with a gradual return to alveolar-interstitial syndrome, then to a normal/nearly normal pattern. Arterial oxygen tension variations were not always consistent with these changes. Conclusions: In a controlled human model of lung air content variation, the different states of aeration deter- mined by WLL procedure were reliably described with lung ultrasound. Keywords Chest ultrasonography Á Lung, ultrasound diagnosis Á Extravascular lung water Á Pulmonary edema Á Whole lung lavage Abbreviations LUS Lung ultrasound OLV One-lung ventilation PaO 2 / FiO 2 Arterial oxygen tension/ inspired oxygen fraction ratio WLL Whole lung lavage Intensive Care Med (2010) 36:999–1007 DOI 10.1007/s00134-010-1834-4 ORIGINAL