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DOI: 10.1055/s-2006-948294
Radiological Imaging in Acute Lung Injury and Acute Respiratory Distress Syndrome
Publikationsverlauf
Publikationsdatum:
14. August 2006 (online)
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ABSTRACT
Computed tomography (CT) has been utilized to study acute respiratory distress syndrome (ARDS) since the middle 1980s, when it revealed the inhomogeneous pattern of the lung lesion. Its advantages rely on the strict correlation between CT density and the lung physical density, allowing a quantification of lung compartments with different degrees of aeration. By CT scans, ARDS lung appeared to be “small” rather than “stiff,” leading to the “baby lung” concept. The regional analysis revealed that this appearance derives from an evenly distributed lung edema, which tends, because of gravitational forces, to lie predominantly in the most dependent regions, leading to alveolar collapse. New data suggest that such a “sponge lung” is made by a “core,” consolidated, lung portion, from which, through an inflammatory reaction, lung edema will spread, determining the collapsed and recruitable lung portion. The amount of recruitable lung varies among ARDS patients. This knowledge is necessary for a rational positive end-expiratory pressure (PEEP) setting because the amount of tissue maintained aerated by PEEP is closely associated with the amount of recruitable lung. CT scans may also help to diagnose ARDS because CT provides a good estimate of the high-permeability lung edema, the characteristic lesion of this syndrome.
KEYWORDS
Acute respiratory distress syndrome - computed tomography - lung recruitment - positive end-expiratory pressure - mechanical ventilation
REFERENCES
- 1 Ashbaugh D G, Bigelow D B, Petty T L, Levine B E. Acute respiratory distress in adults. Lancet. 1967; 2 319-323
- 2 Pontoppidan H, Geffin B, Lowenstein E. Acute respiratory failure in the adult, III. N Engl J Med. 1972; 287 799-806
- 3 Rommelsheim K, Lackner K, Westhofen P, Distelmaier W, Hirt S. Respiratory distress syndrome of the adult in the computer tomograph [in German]. Anasth Intensivther Notfallmed. 1983; 18 59-64
- 4 Gattinoni L, Mascheroni D, Torresin A et al.. Morphological response to positive end expiratory pressure in acute respiratory failure: computerized tomography study. Intensive Care Med. 1986; 12 137-142
- 5 Maunder R J, Shuman W P, McHugh J W, Marglin S I, Butler J. Preservation of normal lung regions in the adult respiratory distress syndrome: analysis by computed tomography. JAMA. 1986; 255 2463-2465
- 6 Gattinoni L, Presenti A, Torresin A et al.. Adult respiratory distress syndrome profiles by computed tomography. J Thorac Imaging. 1986; 1 25-30
- 7 Crotti S, Mascheroni D, Caironi P et al.. Recruitment and derecruitment during acute respiratory failure: a clinical study. Am J Respir Crit Care Med. 2001; 164 131-140
- 8 Downie J M, Nam A J, Simon B A. Pressure-volume curve does not predict steady-state lung volume in canine lavage lung injury. Am J Respir Crit Care Med. 2004; 169 957-962
- 9 Albaiceta G M, Taboada F, Parra D et al.. Tomographic study of the inflection points of the pressure-volume curve in acute lung injury. Am J Respir Crit Care Med. 2004; 170 1066-1072
- 10 Quintel M, Pelosi P, Caironi P et al.. An increase of abdominal pressure increases pulmonary edema in oleic acid-induced lung injury. Am J Respir Crit Care Med. 2004; 169 534-541
- 11 Markstaller K, Eberle B, Kauczor H U et al.. Temporal dynamics of lung aeration determined by dynamic CT in a porcine model of ARDS. Br J Anaesth. 2001; 87 459-468
- 12 Markstaller K, Kauczor H U, Weiler N et al.. Lung density distribution in dynamic CT correlates with oxygenation in ventilated pigs with lavage ARDS. Br J Anaesth. 2003; 91 699-708
- 13 Jones A T, Hansell D M, Evans T W. Pulmonary perfusion in supine and prone positions: an electron-beam computed tomography study. J Appl Physiol. 2001; 90 1342-1348
- 14 Jones A T, Hansell D M, Evans T W. Pulmonary perfusion quantified by electron-beam computed tomography: effects of hypoxia and inhaled NO. Eur Respir J. 2003; 21 855-861
- 15 Gattinoni L, Caironi P, Cressoni M et al.. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006; 354 1775-1786
- 16 Gattinoni L, Caironi P, Pelosi P, Goodman L R. What has computed tomography taught us about the acute respiratory distress syndrome?. Am J Respir Crit Care Med. 2001; 164 1701-1711
- 17 Mull R T. Mass estimates by computed tomography: physical density from CT numbers. AJR Am J Roentgenol. 1984; 143 1101-1104
- 18 Geise R A, McCullough E C. The use of CT scanners in megavoltage photon-beam therapy planning. Radiology. 1977; 124 133-141
- 19 Phelps M E, Gado M H, Hoffman E J. Correlation of effective atomic number and electron density with attenuation coefficients measured with polychromatic x rays. Radiology. 1975; 117(3 Pt 1) 585-588
- 20 Gattinoni L, Pesenti A, Avalli L, Rossi F, Bombino M. Pressure-volume curve of total respiratory system in acute respiratory failure: computed tomographic scan study. Am Rev Respir Dis. 1987; 136 730-736
- 21 Rouby J J, Puybasset L, Nieszkowska A, Lu Q. Acute respiratory distress syndrome: lessons from computed tomography of the whole lung. Crit Care Med. 2003; 31(Suppl 4) S285-S295
- 22 Luecke T, Roth H, Joachim A et al.. Effects of end-inspiratory and end-expiratory pressures on alveolar recruitment and derecruitment in saline-washout-induced lung injury: a computed tomography study. Acta Anaesthesiol Scand. 2004; 48 82-92
- 23 Grasso S, Terragni P, Mascia L et al.. Airway pressure-time curve profile (stress index) detects tidal recruitment/hyperinflation in experimental acute lung injury. Crit Care Med. 2004; 32 1018-1027
- 24 Patroniti N, Bellani G, Manfio A et al.. Lung volume in mechanically ventilated patients: measurement by simplified helium dilution compared to quantitative CT scan. Intensive Care Med. 2004; 30 282-289
- 25 Luecke T, Herrmann P, Kraincuk P, Pelosi P. Computed tomography scan assessment of lung volume and recruitment during high-frequency oscillatory ventilation. Crit Care Med. 2005; 33(Suppl 3) S155-S162
- 26 Gattinoni L, Pelosi P, Crotti S, Valenza F. Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med. 1995; 151 1807-1814
- 27 Pelosi P, Goldner M, McKibben A et al.. Recruitment and derecruitment during acute respiratory failure: an experimental study. Am J Respir Crit Care Med. 2001; 164 122-130
- 28 David M, Karmrodt J, Bletz C et al.. Analysis of atelectasis, ventilated, and hyperinflated lung during mechanical ventilation by dynamic CT. Chest. 2005; 128 3757-3770
- 29 Doebrich M, Markstaller K, Karmrodt J et al.. Analysis of discrete and continuous distributions of ventilatory time constants from dynamic computed tomography. Phys Med Biol. 2005; 50 1659-1673
- 30 Brismar B, Hedenstierna G, Lundquist H, Strandberg A, Svensson L, Tokics L. Pulmonary densities during anesthesia with muscular relaxation: a proposal of atelectasis. Anesthesiology. 1985; 62 422-428
- 31 Gattinoni L, Pesenti A. The concept of “baby lung.” Intensive Care Med. 2005; 31 776-784
- 32 Gattinoni L, Pesenti A, Bombino M, Pelosi P, Brazzi L. Role of extracorporeal circulation in adult respiratory distress syndrome management. New Horiz. 1993; 1 603-612
- 33 Hickling K G, Walsh J, Henderson S, Jackson R. Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study. Crit Care Med. 1994; 22 1568-1578
- 34 Langer M, Mascheroni D, Marcolin R, Gattinoni L. The prone position in ARDS patients: a clinical study. Chest. 1988; 94 103-107
- 35 Gattinoni L, Pelosi P, Vitale G, Pesenti A, D'Andrea L, Mascheroni D. Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure. Anesthesiology. 1991; 74 15-23
- 36 Gattinoni L, Pesenti A, Bombino M et al.. Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology. 1988; 69 824-832
- 37 Pelosi P, D'Andrea L, Vitale G, Pesenti A, Gattinoni L. Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994; 149 8-13
- 38 Jones T, Jones H A, Rhodes C G, Buckingham P D, Hughes J M. Distribution of extravascular fluid volumes in isolated perfused lungs measured with H215O. J Clin Invest. 1976; 57 706-713
- 39 Hales C A, Kanarek D J, Ahluwalia B et al.. Regional edema formation in isolated perfused dog lungs. Circ Res. 1981; 48 121-127
- 40 Bone R C. The ARDS lung: new insights from computed tomography. JAMA. 1993; 269 2134-2135
- 41 Falke K J, Pontoppidan H, Kumar A, Leith D E, Geffin B, Laver M B. Ventilation with end-expiratory pressure in acute lung disease. J Clin Invest. 1972; 51 2315-2323
- 42 Amato M B, Barbas C S, Medeiros D M et al.. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998; 338 347-354
- 43 Villagra A, Ochagavia A, Vatua S et al.. Recruitment maneuvers during lung protective ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2002; 165 165-170
- 44 Brower R G, Morris A, MacIntyre N et al.. Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure. Crit Care Med. 2003; 31 2592-2597
- 45 Lachmann B. Open up the lung and keep the lung open. Intensive Care Med. 1992; 18 319-321
- 46 Villar J, Kacmarek R M, Perez-Mendez L, Aguirre-Jaime A. A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial. Crit Care Med. 2006; 34 1311-1318
- 47 Ranieri V M, Suter P M, Tortorella C et al.. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA. 1999; 282 54-61
- 48 Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000; 342 1301-1308
- 49 Brower R G, Lanken P N, MacIntyre N et al.. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2004; 351 327-336
- 50 Kloot T E, Blanch L, Melynne Y A et al.. Recruitment maneuvers in three experimental models of acute lung injury: effect on lung volume and gas exchange. Am J Respir Crit Care Med. 2000; 161 1485-1494
- 51 Lim S C, Adams A B, Simonson D A et al.. Intercomparison of recruitment maneuver efficacy in three models of acute lung injury. Crit Care Med. 2004; 32 2371-2377
- 52 Gattinoni L, Pelosi P, Suter P M, Pedoto A, Vercesi P, Lissoni A. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease: different syndromes?. Am J Respir Crit Care Med. 1998; 158 3-11
- 53 Murray J F, Matthay M A, Luce J M, Flick M R. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988; 138 720-723
- 54 Bernard G R, Artigas A, Brigham K L et al.. The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994; 149(3 Pt 1) 818-824
- 55 Fink A, Kosecoff J, Chassin M, Brook R H. Consensus methods: characteristics and guidelines for use. Am J Public Health. 1984; 74 979-983
- 56 Ferguson N D, Davis A M, Slutsky A S, Stewart T E. Development of a clinical definition for acute respiratory distress syndrome using the Delphi technique. J Crit Care. 2005; 20 147-154
- 57 Schuster D P. What is acute lung injury? What is ARDS?. Chest. 1995; 107 1721-1726
- 58 Schuster D P. Identifying patients with ARDS: time for a different approach. Intensive Care Med. 1997; 23 1197-1203
Luciano GattinoniM.D.
Istituto di Anestesiologia e Rianimazione, Fondazione IRCCS-“Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena” di Milano, Università
degli Studi di Milano, Via F. Sforza 35, 20122 Milano, Italy
eMail: gattinon@policlinico.mi.it