MONITORING OF PULMONARY EDEMA USING ULTRASOUND RADIOFREQUENCY SIGNAL

Excessive accumulation of extravascular lung water impairs respiratory gas exchange and results in respiratory distress. Real-time radiofrequency signals of ultrasound can continuously and quantitatively monitor excessive lung water. This study aims to evaluate the availability of continuous real-time quantitative pulmonary edema monitoring using ultrasound radiofrequency signals and compare it with Pao2/Fio2 (PF) ratio, conventional lung ultrasound, and the Hounsfield unit of chest computed tomography (CT).Male Yorkshire pigs (40.5 ± 0.5 kg) were anesthetized and mechanically ventilated. A balanced crystalloid was administered to induce hydrostatic pulmonary edema. Three different infusion rates of 2, 4, and 6 ml/kg/min were tested to determine the infusion rate for the appropriate swine model. The chest CTs and ultrasonography with radiofrequency signals were taken every 5 minutes during the full inspiration. The ultrasonography with radiofrequency signals were measured at the intercostal space where the line crossing the two armpits and the right anterior axillary line intersected.The infusion rate of fluid for the pulmonary edema model was determined to be 6 ml/kg/min, and a total of 4 pigs were tested at an injection rate of 6 ml/kg. The adjusted R squared of regression analysis between the radiofrequency signal and computer tomography Hounsfield score was 0.990, 0.993, 0.988, and 0.993 (all p values0.05). All radiofrequency signal changes preceded changes in PaO2/FiO2 (PF ratio) or lung ultrasound changes. The area under the receiver operating characteristic curve of the radiofrequency signal for predicting PF ratio300 was 0.88 (95% confidence interval: 0.82-0.93).We evaluated ultrasound radiofrequency signals to assess pulmonary edema in a swine model that can worsen gradually and showed that quantitative ultrasound radiofrequency signal analysis could assess pulmonary edema and its progression prior to PF ratio or lung ultrasound changes.