Lung Recruitment Assessed by Respiratory Mechanics and Computed Tomography in Patients with Acute Respiratory Distress Syndrome What Is the Relationship?
Lung Recruitment Assessed by Respiratory Mechanics and Computed Tomography in Patients with Acute Respiratory Distress Syndrome What Is the Relationship?
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DOI：
10.1164/rccm.201507-1413oc
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发表时间：
2016-06-01
影响因子：
24.7
通讯作者：
Gattinoni, Luciano
中科院分区：
文献类型：
--
作者：
Chiumello, Davide;Marino, Antonella;Gattinoni, Luciano
基本原理：评估急性呼吸窘迫综合征（ARDS）患者的肺复张能力对于计划肺复张策略和设置呼气末正压（PEEP）可能很重要。目的：确定通过呼吸力学测量的肺复张是否与通过计算机断层扫描（CT）测量的肺复张具有可比性。方法：对22例急性呼吸窘迫综合征（ARDS）患者在5和15 cm H2O PEEP时的肺复张情况进行了呼吸力学评估：（1）两条压力-容积曲线之间的气体容积增加（P-Vrs曲线）;（2）根据预期呼气末肺容量和呼吸系统静态顺应性测量和预测的气体容量增加（EELV-Cst，rs）;以及CT扫描：（3）非充气肺组织减少（CT [未充盈]）;和（4）未充盈和充盈不良组织减少测量和主要结果：P-Vrs曲线募集显著高于EELV-Cst，rs募集（423 +/- 223 ml vs. 315 +/- 201 ml; P < 0.001），但这些测量值彼此显著相关（R-2 = 0.93; P < 0.001）。CT（未充盈）复张为77 +/- 86 g，CT（未充盈+充盈不良）为80 +/- 67 g（P = 0.856），这些测量值也彼此显著相关（R-2 = 0.20; P = 0.04）。在5 cm H2O PEEP时，通过呼吸力学测量的复张为气体体积的54 +/- 28%（P-Vrs曲线）和39 +/- 25%（EELV-Cst，rs）。通过CT扫描测量的肺组织的募集率为5 +/- 5%（CT [未膨胀]）和6 +/- 6%（CT [未+膨胀不良]）。结论：呼吸力学和CT测量在同一术语下，“募集”-两个不同的实体。基于呼吸力学的方法包括气体进入已经开放的肺单元，以提高其在较高PEEP下的机械性能。因此，它们可以用来评估通货膨胀的总体改善情况。CT扫描测量恢复膨胀的塌陷组织的量。
Rationale: The assessment of lung recruitability in patients with acute respiratory distress syndrome (ARDS) may be important for planning recruitment maneuvers and setting positive end-expiratory pressure (PEEP).Objectives: To determine whether lung recruitment measured by respiratory mechanics is comparable with lung recruitment measured by computed tomography (CT).Methods: In 22 patients with ARDS, lung recruitment was assessed at 5 and 15 cm H2O PEEP by using respiratory mechanics-based methods: (1) increase in gas volume between two pressure-volume curves (P-Vrs curve); (2) increase in gas volume measured and predicted on the basis of expected end-expiratory lung volume and static compliance of the respiratory system (EELV-Cst,rs); as well as by CT scan: (3) decrease in noninflated lung tissue (CT [not inflated]); and (4) decrease in noninflated and poorly inflated tissue (CT [not + poorly inflated]).Measurements and Main Results: The P-Vrs curve recruitment was significantly higher than EELV-Cst,rs recruitment (423 +/- 223 ml vs. 315 +/- 201 ml; P < 0.001), but these measures were significantly related to each other (R-2 = 0.93; P < 0.001). CT (not inflated) recruitment was 77 +/- 86 g and CT (not + poorly inflated) was 80 +/- 67 g (P = 0.856), and these measures were also significantly related to each other (R-2 = 0.20; P = 0.04). Recruitment measured by respiratory mechanics was 54 +/- 28% (P-Vrs curve) and 39 +/- 25% (EELV-Cst,rs) of the gas volume at 5 cm H2O PEEP. Recruitment measured by CT scan was 5 +/- 5% (CT [not inflated]) and 6 +/- 6% (CT [not + poorly inflated]) of lung tissue.Conclusions: Respiratory mechanics and CT measure under the same term, "recruitment"-two different entities. The respiratory mechanics-based methods include gas entering in already open pulmonary units that improve their mechanical properties at higher PEEP. Consequently, they can be used to assess the overall improvement of inflation. The CT scan measures the amount of collapsed tissue that regains inflation.