Measurement of regional pleural deformation during mechanical ventilation by ultrasonic elastography: A proof of concept study

August 19, 2021

Martin Girard (1)
Girard's Doctoral Thesis, August 2020.


Anesthesia, General; Humans; Lung/diagnostic imaging/physiopathology; Positive-Pressure Respiration/adverse effects; Ultrasonography/methods; Ventilator-Induced Lung Injury/diagnostic imaging/physiopathology


Mechanical ventilation is a common therapy in operating rooms and intensive care units. When ill-adapted, it can lead to ventilator-induced lung injury (VILI), which in turn is associated with poor outcomes. Excessive regional pulmonary strain is thought to be a major mechanism responsible for VILI. Scarce bedside methods exist to measure regional pulmonary strain. We propose a novel way to measure regional pleural strain using ultrasound elastography. We conducted a single blind randomized crossover pilot study in 10 patients requiring general anesthesia. After induction, patients were received tidal volumes of 6, 8, 10 and 12 in random order, while pleural ultrasound cineloops were acquired at 4 standardized locations. Ultrasound radiofrequency speckle tracking allowed computing various pleural translation, strain and shear components. These were screened to identify those with the best dose-response with tidal volumes using linear mixed effect models. Goodness-of-fit was assessed by the coefficient of determination. Intraobserver, interobserver and test-retest reliability were calculated using intraclass correlation coefficients. Analysis was possible in 90.7% of ultrasound cineloops. Lateral absolute shear, lateral absolute strain and Von Mises strain varied significantly with tidal volume and offered the best dose-responses and data modelling fits. Point estimates for intraobserver reliability measures were excellent for all 3 parameters (0.94, 0.94 and 0.93, respectively). Point estimates for interobserver (0.84, 0.83 and 0.77, respectively) and test-retest (0.85, 0.82 and 0.76, respectively) reliability measures were good. Thus, strain imaging is feasible and reproducible, and may eventually guide mechanical ventilation strategies in larger cohorts of patients.

How Our Software Was Used

Dragonfly was used to compute elastography images and mechanical parameters within the ROI over consecutive frames.

Author Affiliation

(1) Department of Anaesthesiology, Centre hospitalier de l’Université de Montréal, 1000 rue St-Denis, Montréal, Qc, Canada, H2X 3J4.