Acute respiratory distress syndrome: Lessons from computed tomography of the whole lung

Rouby, Jean‐Jacques; Puybasset, Louis; Nieszkowska, Ania; Lü, Qin

doi:10.1097/01.ccm.0000057905.74813.bc

Cited by 237 publications

(199 citation statements)

References 37 publications

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“…[88][89][90][91] CT imaging has long been the accepted standard for assessments of alveolar recruitment and overdistention. Digital chest radiography done at the bedside with PEEP of 5 and 15 cm H 2 O might also be useful to detect recruited lung volume.…”

Section: Imagingmentioning

confidence: 99%

Recruitment Maneuvers and PEEP Titration

2015

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The injurious effects of alveolar overdistention are well accepted, and there is little debate regarding the importance of pressure and volume limitation during mechanical ventilation. The role of recruitment maneuvers is more controversial. Alveolar recruitment is desirable if it can be achieved, but the potential for recruitment is variable among patients with ARDS. A stepwise recruitment maneuver, similar to an incremental PEEP titration, is favored over sustained inflation recruitment maneuvers. Many approaches to PEEP titration have been proposed, and the best method to choose the most appropriate level for an individual patient is unclear. A PEEP level should be selected that balances alveolar recruitment against overdistention. The easiest approach to select PEEP might be according to the severity of the disease: 5-10 cm H 2 O PEEP in mild ARDS, 10 -15 cm H 2 O PEEP in moderate ARDS, and 15-20 cm H 2 O PEEP in severe ARDS. Recruitment maneuvers and PEEP should be used within the context of lung protection and not just as a means of improving oxygenation.

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Section: Imagingmentioning

confidence: 99%

Recruitment Maneuvers and PEEP Titration

2015

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“…Considering a whole lung CT scan the number of images that must be delineated usually ranges from 40 to 60, depending on the height of the subject, the thickness and the interval of the images. Thus the quantitative analysis is very laborious and time consuming, which precludes its use in the daily patient management [35,37,38]. In order to expand the possibility to use the quantitative analysis to estimate lung recruitment, Lu et al studied only one or three lung CT images instead of the whole lung CT scan, which required a significantly lower time [7].…”

Section: Discussionmentioning

confidence: 99%

“…Owing to the linear correlation between the CT attenuation and the density of the lung [37], we tested the accuracy of a visual assessment of percentage of consolidated/collapsed areas compared to a quantitative analysis. The consolidated/collapsed areas, which radiologically appear as areas of homogeneous decrease of lung attenuation, correspond to not aerated lung regions in the quantitative analysis.…”

Section: Discussionmentioning

confidence: 99%

Visual anatomical lung CT scan assessment of lung recruitability

et al. 2012

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Purpose: The computation of lung recruitability in acute respiratory distress syndrome (ARDS) is advocated to set positive end-expiratory pressure (PEEP) for preventing lung collapse. The quantitative lung CT scan, obtained by manual image processing, is the reference method but it is time consuming. The aim of this study was to evaluate the accuracy of a visual anatomical analysis compared with a quantitative lung CT scan analysis in assessing lung recruitability. Methods: Fifty sets of two complete lung CT scans of ALI/ARDS patients computing lung recruitment were analyzed. Lung recruitability computed at an airway pressure of 5 and 45 cmH 2 O was defined as the percentage decrease in the collapsed/ consolidated lung parenchyma assessed by two expert radiologists using a visual anatomical analysis and as the decrease in not aerated lung regions using a quantitative analysis computed by dedicated software.Results: Lung recruitability was 11.3 % (interquartile range 7.39-16.41) and 15.5 % (interquartile range 8.18-21.43) with the visual anatomical and quantitative analysis, respectively. In the Bland-Altman analysis, the bias and agreement bands between the visual anatomical and quantitative analysis were -2.9 % (-11.8 to ?5.9 %). The ROC curve showed that the optimal cutoff values for the visual anatomical analysis in predicting high versus low lung recruitability was 8.9 % (area under the ROC curve 0.9248, 95 % CI 0.8550-0.9946). Considering this cutoff, the sensitivity, specificity, and diagnostic accuracy were 0.96, 0.76, and 0.86, respectively. Conclusions: Visual anatomical analysis can classify patients into those with high and low lung recruitability allowing more intensivists to get access to lung recruitability assessment.

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“…Em investigação pregressa, também em pacientes no pós-operatório de intervenção cirúrgica cardíaca, demonstrou-se que a aplicação progressiva da PEEP até 15 cm de H 2 O foi efetiva em aumentar a oxigenação com mínimos efeitos hemodinâ-micos negativos 5 . Embora não seja o escopo do presente trabalho, aumentar a oxigenação e reabrir unidades alveolares em atelectasias, com diferentes estratégias, tem sido o grande paradigma em pacientes acometidos por SARA [17][18][19][20][21][22] . Lachman foi um dos pioneiros em difundir o conceito e estratégia para abrir unidades alveolares colapsadas e mantê-las abertas 17 .…”

Section: Discussionunclassified

“…Como foi comentado, toda essa estratégia de aplicação da PEEP e MRA para desfazer áreas de colapso alveolar apresentou enorme crescimento científico nos últimos anos, em sua quase totalidade com enfoque em pacientes com SARA. Embora ainda não haja consenso de valores empregados na MRA e PEEP, muitos desses estudos, embasados em métodos por imagem, mostraram a importância da MRA na melhoria da oxigenação [18][19][20] . Mesmo sendo a fisiopatologia da SARA diferente, a estratégia para tratamento da hipoxemia nestes pacientes, que inclui MRA [18][19][20][21][22] , bem como estudos específicos em cirurgia cardíaca utilizando a mesma técnica 6 , referendaram e motivaram a condução dessa presente investigação.…”

Section: Discussionunclassified