Functional Respiratory Imaging of the Airways in the Acute Respiratory Distress Syndrome.
Anaesthesia Critical Care & Pain Medicine
Available online 7 February 2020
https://doi.org/10.1016/j.accpm.2019.10.017
Schepens, Xiao, Holsbeke CV, Vos W, Backer J, Parizel PM, Backer W, Qin L6, Rouby JJ, Jorens PG.
Abstract
BACKGROUND:
Alveolar flooding and airway obstruction are present in the acute respiratory distress syndrome. The impact of positive end-expiratory pressure on regional airway aeration has not been described.
AIM:
To assess bronchial and lung recruitment and distension during an incremental positive end-expiratory pressure trial in patients with acute respiratory distress syndrome.
METHODS:
Six patients underwent lung and airway imaging at four positive end-expiratory pressure levels in a cohort trial. Images were post-processed by means of Functional Respiratory Imaging. This technique offers 3-dimensional visualisation and quantification of patients’ airway and lung geometry on a regional level.
RESULTS:
With increasing positive end-expiratory pressure from 0 to 20 cmH2O (high), the median bronchial recruitment was 151% and the median bronchial distension 43%. Non-aerated lower lobes bronchi had more bronchial volume increase at high positive end-expiratory pressure than partially aerated upper lobes bronchi. Lung recruitment tended to be higher in patients with non-focal acute respiratory distress syndrome. In two patients, bronchial volume increase at high positive end-expiratory pressure largely exceeded bronchial volume increase observed in matched healthy control subjects at total lung capacity, suggesting severe bronchial over-distension.
CONCLUSIONS:
In early acute respiratory distress syndrome, Functional Respiratory Imaging gives an innovative insight into the relationship between positive end-expiratory pressure-induced bronchial distension and recruitment, positive end-expiratory pressure-induced lung recruitment and hyperinflation and lung morphology.
Copyright © 2020 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
Categorised in: Papers / February 12, 2020 11:26 pm /