Hyperpolarized gas diffusion MRI for the study of atelectasis and acute respiratory distress syndrome

Cereda, Maurizio; Xin, Yi; Kadlecek, Stephen; Hamedani, Hooman; Rajaei, Jennia; Clapp, Justin T.; Rizi, Rahim R.

doi:10.1002/nbm.3136

Cited by 10 publications

(5 citation statements)

References 129 publications

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“…Similarly, Seah et al showed that over-distension caused by high Vt did not cause lung histopathology unless it was combined with high dynamic strain when PEEP is set at zero [ 42 , 43 ]. Using a novel method of polarized gas inhalation, which can identify the dynamic change in structures as small as alveoli and alveolar ducts, it was shown that increasing lung volume with PEEP actually decreased alveolar size, while increasing alveolar number [ 44 ]. Thus, the ‘hyper-inflated’ lung tissue seen on CT might not be caused by over-distended alveoli but rather by an increase in the number of smaller, newly recruited alveoli.…”

Section: Reviewmentioning

confidence: 99%

Personalizing mechanical ventilation according to physiologic parameters to stabilize alveoli and minimize ventilator induced lung injury (VILI)

Nieman

Satalin

Andrews

et al. 2017

ICMx

107

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It has been shown that mechanical ventilation in patients with, or at high-risk for, the development of acute respiratory distress syndrome (ARDS) can be a double-edged sword. If the mechanical breath is improperly set, it can amplify the lung injury associated with ARDS, causing a secondary ventilator-induced lung injury (VILI). Conversely, the mechanical breath can be adjusted to minimize VILI, which can reduce ARDS mortality. The current standard of care ventilation strategy to minimize VILI attempts to reduce alveolar over-distension and recruitment-derecruitment (R/D) by lowering tidal volume (Vt) to 6 cc/kg combined with adjusting positive-end expiratory pressure (PEEP) based on a sliding scale directed by changes in oxygenation. Thus, Vt is often but not always set as a “one-size-fits-all” approach and although PEEP is often set arbitrarily at 5 cmH2O, it may be personalized according to changes in a physiologic parameter, most often to oxygenation. However, there is evidence that oxygenation as a method to optimize PEEP is not congruent with the PEEP levels necessary to maintain an open and stable lung. Thus, optimal PEEP might not be personalized to the lung pathology of an individual patient using oxygenation as the physiologic feedback system. Multiple methods of personalizing PEEP have been tested and include dead space, lung compliance, lung stress and strain, ventilation patterns using computed tomography (CT) or electrical impedance tomography (EIT), inflection points on the pressure/volume curve (P/V), and the slope of the expiratory flow curve using airway pressure release ventilation (APRV). Although many studies have shown that personalizing PEEP is possible, there is no consensus as to the optimal technique. This review will assess various methods used to personalize PEEP, directed by physiologic parameters, necessary to adaptively adjust ventilator settings with progressive changes in lung pathophysiology.

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Section: Reviewmentioning

confidence: 99%

Personalizing mechanical ventilation according to physiologic parameters to stabilize alveoli and minimize ventilator induced lung injury (VILI)

Nieman

Satalin

Andrews

et al. 2017

ICMx

107

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“…Tomographic lung imaging (e.g., including CT, positron emission tomography [PET], and electrical impedance tomography [EIT]), magnetic resonance imaging (MRI), and lung ultrasound (LUS) provide useful data to improve strategies to prevent VILI. 241 242 As lung monitoring by lung imaging is not specifically part of this chapter, we refer—for the reader—to the most updated guidelines or leading reports detailing the potential of lung imaging in the diagnostics and in the evaluation of the lung injury severity through CT, 143 PET, 243 EIT, 244 MRI, 245 246 and LUS. 247 248…”

Section: Future Research Directionmentioning

confidence: 99%

Monitoring Lung Injury Severity and Ventilation Intensity during Mechanical Ventilation

Rezoagli

Laffey

Bellani

2022

Semin Respir Crit Care Med

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Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure burden by high hospital mortality. No specific pharmacologic treatment is currently available and its ventilatory management is a key strategy to allow reparative and regenerative lung tissue processes. Unfortunately, a poor management of mechanical ventilation can induce ventilation induced lung injury (VILI) caused by physical and biological forces which are at play. Different parameters have been described over the years to assess lung injury severity and facilitate optimization of mechanical ventilation. Indices of lung injury severity include variables related to gas exchange abnormalities, ventilatory setting and respiratory mechanics, ventilation intensity, and the presence of lung hyperinflation versus derecruitment. Recently, specific indexes have been proposed to quantify the stress and the strain released over time using more comprehensive algorithms of calculation such as the mechanical power, and the interaction between driving pressure (DP) and respiratory rate (RR) in the novel DP multiplied by four plus RR [(4 × DP) + RR] index. These new parameters introduce the concept of ventilation intensity as contributing factor of VILI. Ventilation intensity should be taken into account to optimize protective mechanical ventilation strategies, with the aim to reduce intensity to the lowest level required to maintain gas exchange to reduce the potential for VILI. This is further gaining relevance in the current era of phenotyping and enrichment strategies in ARDS.

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“…1 and Supplemental Animation S1). Thus dynamic strain is minimal in normal alveoli (15,16,45). Loss of surfactant function with acute lung injury renders alveoli unstable, greatly reducing the alveolar collapse time constant, resulting in a rapid collapse of the alveolus with each expiration (58; Fig.…”

Section: Pathophysiology Of Vilimentioning

confidence: 99%

Physiology in Medicine: Understanding dynamic alveolar physiology to minimize ventilator-induced lung injury

Nieman

Satalin

Kollisch-Singule

et al. 2017

Journal of Applied Physiology

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Acute respiratory distress syndrome (ARDS) remains a serious clinical problem with the main treatment being supportive in the form of mechanical ventilation. However, mechanical ventilation can be a double-edged sword: if set improperly, it can exacerbate the tissue damage caused by ARDS; this is known as ventilator-induced lung injury (VILI). To minimize VILI, we must understand the pathophysiologic mechanisms of tissue damage at the alveolar level. In this Physiology in Medicine paper, the dynamic physiology of alveolar inflation and deflation during mechanical ventilation will be reviewed. In addition, the pathophysiologic mechanisms of VILI will be reviewed, and this knowledge will be used to suggest an optimal mechanical breath profile (MB: all airway pressures, volumes, flows, rates, and the duration that they are applied at both inspiration and expiration) necessary to minimize VILI. Our review suggests that the current protective ventilation strategy, known as the "open lung strategy," would be the optimal lung-protective approach. However, the viscoelastic behavior of dynamic alveolar inflation and deflation has not yet been incorporated into protective mechanical ventilation strategies. Using our knowledge of dynamic alveolar mechanics (i.e., the dynamic change in alveolar and alveolar duct size and shape during tidal ventilation) to modify the MB so as to minimize VILI will reduce the morbidity and mortality associated with ARDS.

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Hyperpolarized gas diffusion MRI for the study of atelectasis and acute respiratory distress syndrome

Cited by 10 publications

References 129 publications

Personalizing mechanical ventilation according to physiologic parameters to stabilize alveoli and minimize ventilator induced lung injury (VILI)

Personalizing mechanical ventilation according to physiologic parameters to stabilize alveoli and minimize ventilator induced lung injury (VILI)

Monitoring Lung Injury Severity and Ventilation Intensity during Mechanical Ventilation

Physiology in Medicine: Understanding dynamic alveolar physiology to minimize ventilator-induced lung injury

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