Evaluation of Recruited Lung Volume at Inspiratory Plateau Pressure With PEEP Using Bedside Digital Chest X-ray in Patients With Acute Lung Injury/ARDS
Evaluation of Recruited Lung Volume at Inspiratory Plateau Pressure With PEEP Using Bedside Digital Chest X-ray in Patients With Acute Lung Injury/ARDS
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DOI：
10.4187/respcare.01893
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发表时间：
2013-03-01
期刊：
影响因子：
2.5
通讯作者：
Guerin, Claude
中科院分区：
文献类型：
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作者：
Wallet, Florent;Delannoy, Bertrand;Guerin, Claude
背景：我们想要评估在急性肺损伤或ARDS患者中，在两种不同水平的吸气平台压对应于两个PEEP水平时，数字处理胸部X线片上测量的招募肺体积(V-rec)与密度变化之间是否存在显著关系。方法：14例受试者按随机顺序前瞻性应用PEEP 5 cm H2O和15 cm 1120，持续10分钟。在每个周期结束时，使用数字便携式设备拍摄胸部X线片，并绘制呼吸系统的压力-容量曲线。我们还评估了P-AO2，以及呼吸系统的静态和动态(C-dyn，C-Rs)顺应性。测定呼气末肺活量在潮气呼吸和呼吸系统松弛容量之间的变化。使用专用软件测量右肺4个感兴趣区和左肺3个感兴趣区的胸部X线衰减，从上到下绘制在肋间后间隙。计算PEEP15与PEEP5之间各区域肺密度的比值(rP15/P5)及其算术平均值(muP15/P5)。V-rec由压力-体积曲线确定。结果：98个肺水平rP15/P5的中位数为0.91(0.80~1.01)，与1有显著差异(P<0.01)。RP15/P5值在肺水平之间无显著差异。V-rec和muP15/P5的中位数分别为288(173-402)mL和0.90(0.80-0.97)。V-rec与muP15/P5呈显著负相关(R=-0.77，P=0.01)。在PEEP 15cmH2O和PEEP5cmH2O之间，MUP15/P5的降低倾向于与C-dyn、C-Rs(R=-0.49，P=0.077)或P-AO2(R=-0.53，P=0.05)的增加相关。结论：急性肺损伤/ARDS患者床边数字胸片可检测到PEEP 5cmH2O和PEEP15cmH2O之间的密度降低，并与V-rec相关。
BACKGROUND: We wanted to assess whether there was a significant relationship between recruited lung volume (V-rec) and change in density on digital processed chest x-ray measured at 2 different levels of inspiratory plateau pressure corresponding to 2 PEEP levels in patients with acute lung injury or ARDS. METHODS: In 14 subjects, PEEP 5 cm H2O and 15 cm 1120 were prospectively applied in a random order for 10 min. At the end of each period, chest x-ray was taken using a digital portable device, and a pressure-volume curve of the respiratory system was performed. We also assessed P-aO2, and the static and the dynamic (C-dyn,C-rs) compliance of the respiratory system. Change in end-expiratory lung volume between tidal breath and relaxation volume of the respiratory system was determined. Radiological attenuation was measured on chest x-rays in 4 regions of interest in the right lung, and in 3 regions of interest in the left lung, drawn in posterior intercostal spaces from top to bottom, by using dedicated software. The ratio of lung density in each region between PEEP 15 and PEEP 5 (rP15/P5) and their arithmetic mean (mu P15/P5) were computed. V-rec was determined from the pressure-volume curves. RESULTS: The median value of rP15/P5 in the 98 lung levels was 0.91 (0.80-1.01), which was significantly different from 1 (P < .001). The values of rP15/P5 were not significantly different between the lung levels. The median values of V-rec and mu P15/P5 were 288 (173-402) mL and 0.90 (0.80-0.97), respectively. There was a significant negative correlation between V-rec and mu P15/P5 (R = -0.77, P = .01). The reduction in mu P15/P5 tended to correlate with the increase in C-dyn,C-rs (R = -0.49, P = .077) or in P-aO2 (R = -0.53, P = .05) between PEEP 15 cm H2O and PEEP 5 cm H2O. CONCLUSIONS: Digital chest x-ray done at the bedside in acute lung injury/ARDS subjects was able to detect a reduction in density between PEEP 5 cm H2O and PEEP 15 cm H2O, which correlated with V-rec.