Computed tomography assessment of positive end-expiratory pressure-induced alveolar recruitment in patients with acute respiratory distress syndrome
Computed tomography assessment of positive end-expiratory pressure-induced alveolar recruitment in patients with acute respiratory distress syndrome
复制标题
DOI：
10.1164/ajrccm.163.6.2005001
复制
发表时间：
2001-05-01
影响因子：
24.7
通讯作者：
Rouby, JJ
中科院分区：
文献类型：
--
作者：
Malbouisson, LM;Muller, JC;Rouby, JJ
呼气末正压（PEEP）诱导肺泡复张的计算机断层扫描（CT）评估通常通过量化单个相邻切片上非充气肺实质的减少来实现（Gattinoni方法）。这种方法忽略了在通气不良的肺区域发生的肺泡复张，并且可能不能反映整个肺的肺泡复张。本研究描述了一种新的CT方法，其中PEEP诱导的肺泡复张被计算为PEEP后在通气不良和非通气肺区域的气体渗透量。对16例急性呼吸窘迫综合征患者在ZEEP和PEEP 15 cm H2O下进行胸部螺旋CT扫描。根据新的方法，PEEP诱导功能残气量（FRC）增加119%。PEEP诱导的肺泡复张为499 +/- 279 ml，而先前通气的肺区域的膨胀和过度膨胀分别为395 +/- 382 ml和28 +/- 6 ml。根据Gattinoni的方法，肺泡复张为26 +/- 24 g，两种方法之间没有发现相关性。仅当通过新方法评估肺复张时，发现PEEP诱导的肺泡复张与Pa增加之间存在显著相关性（Rho = 0.76，p = 0.003），这表明它可能比Gattinoni的方法更准确。
Computed tomography (CT) assessment of positive end-expiratory pressure (PEEP)-induced alveolar recruitment is classically achieved by quantifying the decrease in nonaerated lung parenchyma on a single juxtadiaphragmatic section (Gattinoni's method). This approach ignores the alveolar recruitment occurring in poorly aerated lung areas and may not reflect the alveolar recruitment of the entire lung. This study describes a new CT method in which PEEP-induced alveolar recruitment is computed as the volume of gas penetrating in poorly and nonaerated lung regions following PEEP. In 16 patients with acute respiratory distress syndrome a thoracic spiral CT scan was performed in ZEEP and PEEP 15 cm H2O. According to the new method, PEEP induced a 119% increase in functional residual capacity (FRC). PEEP-induced alveolar recruitment was 499 +/- 279 ml whereas distension and overdistension of previously aerated lung areas were 395 +/- 382 ml and 28 +/- 6 ml, respectively. The alveolar recruitment according to Gattinoni's method was 26 +/- 24 g and no correlation was found between both methods. A significant correlation was found between PEEP-induced alveolar recruitment and increase in Pa,, only when recruitment was assessed by the new method (Rho = 0.76, p = 0.003), suggesting that it may be more accurate than Gattinoni's method.