Radiological pattern in ARDS patients: partitioned respiratory mechanics, gas exchange and lung recruitability.
Radiological pattern in ARDS patients: partitioned respiratory mechanics, gas exchange and lung recruitability.
复制标题
ARDS患者的放射学模式：分配的呼吸技术，气体交换和肺募养性。
DOI：
10.1186/s13613-021-00870-0
复制
发表时间：
2021-05-17
影响因子：
8.1
通讯作者：
Chiumello D
中科院分区：
文献类型：
--
作者：
Coppola S;Pozzi T;Gurgitano M;Liguori A;Duka E;Bichi F;Ciabattoni A;Chiumello D
ARDS的特点是不同程度的氧合损害和肺部疾病的分布。已经描述了两种放射学模式：局灶性和弥漫性。这两种模式可能在气体交换和对募集动作的反应方面存在显着差异。目前，还不清楚局灶性和弥漫性模式是否可以通过肺和胸壁机械特征的差异来表征。我们的目的是调查，在两个水平的PEEP，如果局灶性与弥漫性ARDS模式可以通过不同的肺部CT特征，分区呼吸力学和肺复张性。由两名放射科医生分析CT模式，并将其分为局灶性或弥漫性。分析5 ~ 15 cmH 2 O时血气分析及分区呼吸力学的变化。在PEEP为5和45 cmH 2 O时进行肺CT扫描，以评估肺的复张性。110例患者表现为弥漫性模式，58例表现为局灶性模式。在PEEP为5 cmH 2 O时，弥散模式下呼吸系统和肺的驱动压力和弹性显著高于局灶模式（14 [11-16] vs 11 [9-15 cmH 2 O; 28 [23-34] vs 21 [17-27] cmH 2 O/L; 22 [17-28] vs 14 [12-19] cmH 2 O/L）。通过增加PEEP，弥散模式下的驱动压和呼吸系统弹性显著降低，而局灶模式下的驱动压和呼吸系统弹性增加或不变（Δ15-5：− 1 [− 2至1] vs 0 [− 1至2]; − 1 [− 4至2] vs 1 [− 2至5]）。在PEEP为5 cmH 2 O时，弥散模式的肺气体含量（743 [537-984] vs 1222 [918-1974] mL）低于局灶模式，肺重量（1618 [1388-2001] vs 1222 [1059-1394] g）高于局灶模式。弥漫性肺复张率显著高于局灶性肺复张率（21% [13-29] vs 11% [6-16]）。考虑到整个人群的肺复张率中位数（16.1%），弥漫型和局灶型复张者分别为65%和22%。肺形态学的早期识别可用于选择解释设置。扩散模式对PEEP的增加和复张策略有更好的反应。在线版本包含补充材料，可通过10.1186/s13613-021-00870-0获得。
The ARDS is characterized by different degrees of impairment in oxygenation and distribution of the lung disease. Two radiological patterns have been described: a focal and a diffuse one. These two patterns could present significant differences both in gas exchange and in the response to a recruitment maneuver. At the present time, it is not known if the focal and the diffuse pattern could be characterized by a difference in the lung and chest wall mechanical characteristics. Our aims were to investigate, at two levels of PEEP, if focal vs. diffuse ARDS patterns could be characterized by different lung CT characteristics, partitioned respiratory mechanics and lung recruitability. CT patterns were analyzed by two radiologists and were classified as focal or diffuse. The changes from 5 to 15 cmH2O in blood gas analysis and partitioned respiratory mechanics were analyzed. Lung CT scan was performed at 5 and 45 cmH2O of PEEP to evaluate lung recruitability. One-hundred and ten patients showed a diffuse pattern, while 58 showed a focal pattern. At 5 cmH2O of PEEP, the driving pressure and the elastance, both the respiratory system and of the lung, were significantly higher in the diffuse pattern compared to the focal (14 [11–16] vs 11 [9–15 cmH2O; 28 [23–34] vs 21 [17–27] cmH2O/L; 22 [17–28] vs 14 [12–19] cmH2O/L). By increasing PEEP, the driving pressure and the respiratory system elastance significantly decreased in diffuse pattern, while they increased or did not change in the focal pattern (Δ15-5: − 1 [− 2 to 1] vs 0 [− 1 to 2]; − 1 [− 4 to 2] vs 1 [− 2 to 5]). At 5 cmH2O of PEEP, the diffuse pattern had a lower lung gas (743 [537–984] vs 1222 [918–1974] mL) and higher lung weight (1618 [1388–2001] vs 1222 [1059–1394] g) compared to focal pattern. The lung recruitability was significantly higher in diffuse compared to focal pattern 21% [13–29] vs 11% [6–16]. Considering the median of lung recruitability of the whole population (16.1%), the recruiters were 65% and 22% in the diffuse and focal pattern, respectively. An early identification of lung morphology can be useful to choose the ventilatory setting. A diffuse pattern has a better response to the increase of PEEP and to the recruitment maneuver. The online version contains supplementary material available at 10.1186/s13613-021-00870-0.
登录
查看更多内容
影响因子：
8.8
作者：
Grasso, S;Mascia, L;Ranieri, VM
通讯作者：
Ranieri, VM
DOI：
10.1164/rccm.200710-1589oc
发表时间：
2008-08-15
影响因子：
24.7
作者：
Chiumello, Davide;Carlesso, Eleonora;Gattinoni, Luciano
通讯作者：
Gattinoni, Luciano
影响因子：
76.2
作者：
Constantin, Jean-Michel;Jabaudon, Matthieu;Futier, Emmanuel
通讯作者：
Futier, Emmanuel
影响因子：
38.9
作者：
Rouby, JJ;Puybasset, L;Grenier, P
通讯作者：
Grenier, P
影响因子：
8.8
作者：
GATTINONI, L;PESENTI, A;TORRESIN, A
通讯作者：
TORRESIN, A