How to monitor lung recruitment in patients with acute lung injury

Current Opinion in Critical Care

Volumn 13, Issue 3, 2007, Pages 338-343

  Caironi, Pietro ^a   Gattinoni, Luciano ^a  

^a UNIVERSITY OF MILAN   (Italy)

Author keywords

Acute respiratory distress syndrome; Atelectasis; Computed tomography; Imaging techniques; Pulmonary gas exchange

Indexed keywords

ACUTE LUNG INJURY; ADULT RESPIRATORY DISTRESS SYNDROME; ARTIFICIAL VENTILATION; BIOTECHNOLOGY; CLINICAL PRACTICE; COMPUTER ASSISTED TOMOGRAPHY; GAS EXCHANGE; HUMAN; LUNG PARENCHYMA; LUNG RECEPTOR; PATHOPHYSIOLOGY; PATIENT MONITORING; PNEUMOGRAPHY; POSITRON EMISSION TOMOGRAPHY; RESPIRATORY SYSTEM; REVIEW; STANDARD;

CARBON DIOXIDE; HUMANS; LUNG; MONITORING, PHYSIOLOGIC; OXYGEN; RESPIRATORY DISTRESS SYNDROME, ADULT; RESPIRATORY FUNCTION TESTS; SENSITIVITY AND SPECIFICITY;

EID: 34249109721     PISSN: 10705295     EISSN: 15317072     Source Type: Journal    
DOI: 10.1097/MCC.0b013e32814db80c     Document Type: Review

References (42)

1. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967; 2:319-323.
2. Falke KJ, Pontoppidan H, Kumar A, et al. Ventilation with end-expiratory pressure in acute lung disease. J Clin Invest 1972; 51:2315-2323.
3. Villar J. The use of positive end-expiratory pressure in the management of the acute respiratory distress syndrome. Minerva Anestesiol 2005; 71:265-272.
4. Villar J. Low vs high positive end-expiratory pressure in the ventilatory management of acute lung injury. Minerva Anestesiol 2006; 72:357-362.
5. Mead J, Takishima T, Leith D. Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol 1970; 28:596-608.
6. Muscedere JG, Mullen JB, Gan K, Slutsky AS. Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 1994; 149:1327-1334.
7. Gattinoni L, Caironi P, Cressoni M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 2006; 354:1775-1786. This is the largest study on lung recruitment in ALI/ARDS patients with the use of whole-lung CT scanning. It also compares CT scanning with respiratory variables derived from PEEP trials.
8. Koh WJ, Suh GY, Han J, et al. Recruitment maneuvers attenuate repeated derecruitment-associated lung injury. Crit Care Med 2005; 33:1070-1076.
9. Takeuchi M, Imanaka H, Tachibana K, et al. Recruitment maneuver and high positive end-expiratory pressure improve hypoxemia in patients after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism. Crit Care Med 2005; 33:2010-2014.
10. Richard JC, Maggiore SM, Mancebo J, et al. Effects of vertical positioning on gas exchange and lung volumes in acute respiratory distress syndrome. Intensive Care Med 2006; 32:1623-1626.
11. Richard JC, Le Bars D, Costes N, et al. Alveolar recruitment assessed by positron emission tomography during experimental acute lung injury. Intensive Care Med 2006; 32:1889-1894. This is an important study reporting the use of PET as a tool to assess lung recruitment. It compares this technique with lung recruitment derived from pressure-volume-curve analysis.
12. Frerichs I, Dargaville PA, van Genderingen H, et al. Lung volume recruitment after surfactant administration modifies spatial distribution of ventilation. Am J Respir Crit Care Med 2006; 174:772-779. Here experimental evidence is provided of the utility of recruitment maneuvers in increasing the efficacy of surfactant therapy.
13. Henzler D, Pelosi P, Dembinski R, et al. Respiratory compliance but not gas exchange correlates with changes in lung aeration after a recruitment maneuver: an experimental study in pigs with saline lavage lung injury. Crit Care 2005; 9:R471-R482.
14. Borges JB, Okamoto VN, Matos GF, et al. Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome. Am J Respir Crit Care Med 2006; 174:268-278. This paper provides important clinical evidence based on CT-scan analysis of the mechanisms regulating lung recruitment after the application of increasing airway pressures. Nonetheless, it presents a confusing interpretation of variation in gas exchange during lung recruitment.
15. Galiatsou E, Kostanti E, Svarna E, et al. Prone position augments recruitment and prevents alveolar overinflation in acute lung injury. Am J Respir Crit Care Med 2006; 174:187-197. This is an excellent study reporting the effects of prone positioning and recruitment maneuvers on lung recruitment, as assessed by CT scan, and gas exchange in ARDS patients. It reports differences in the response to these procedures between patients with either lobar or diffuse injury.
16. Lemaire F, Gastine H, Regnier B, et al. Changes in intrapulmonary shunting with alterations in pulmonary vascular resistance. Anesthesiology 1977; 47:315-316.
17. Lynch JP, Mhyre JG, Dantzker DR. Influence of cardiac output on intrapulmonary shunt. J Appl Physiol 1979; 46:315-321.
18. Gattinoni L, Vagginelli F, Carlesso E, et al. Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Crit Care Med 2003; 31:2727-2733.
19. Ranieri VM, Brienza N, Santostasi S, et al. Impairment of lung and chest wall mechanics in patients with acute respiratory distress syndrome: role of abdominal distension. Am J Respir Crit Care Med 1997; 156:1082-1091.
20. Gattinoni L, Pelosi P, Suter PM, et al. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 1998; 158:3-11.
21. Jonson B, Richard JC, Straus C, et al. Pressure-volume curves and compliance in acute lung injury: evidence of recruitment above the lower inflection point. Am J Respir Crit Care Med 1999; 159:1172-1178.
22. Aboab J, Jonson B, Kouatchet A, et al. Effect of inspired oxygen fraction on alveolar derecruitment in acute respiratory distress syndrome. Intensive Care Med 2006; 32:1979-1986. This study reports a protective effect of high PEEP levels on the development of reabsorption atelectasis.
23. Stahl CA, Moller K, Schumann S, et al. Dynamic versus static respiratory mechanics in acute lung injury and acute respiratory distress syndrome. Crit Care Med 2006; 34:2090-2098.
24. Gattinoni L, Pesenti A. The concept of 'baby lung'. Intensive Care Med 2005; 31:776-784.
25. Bellardine CL, Hoffman AM, Tsai L, et al. Comparison of variable and conventional ventilation in a sheep saline lavage lung injury model. Crit Care Med 2006; 34:439-445. This is an interesting study reporting the beneficial effect of variable ventilation on the functionality of the respiratory system in an experimental model of ALI. It also reports the dynamics of lung derecruitment after the application of a recruitment maneuver.
26. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med 2000; 342:1334-1349.
27. Gattinoni L, Caironi P, Pelosi P, Goodman LR. What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 2001; 164:1701-1711.
28. Maunder RJ, Shuman WP, McHugh JW, et al. Preservation of normal lung regions in the adult respiratory distress syndrome. Analysis by computed tomography. JAMA 1986; 255:2463-2465.
29. Gattinoni L, Mascheroni D, Torresin A, et al. Morphological response to positive end expiratory pressure in acute respiratory failure. Computerized tomography study. Intensive Care Med 1986; 12:137-142.
30. Luecke T, Roth H, Joachim A, et al. Effects of end-inspiratory and endexpiratory pressures on alveolar recruitment and derecruitment in saline-washout-induced lung injury - a computed tomography study. Acta Anaesthesiol Scand 2004; 48:82-92.
31. Karmrodt J, Bletz C, Yuan S, et al. Quantification of atelectatic lung volumes in two different porcine models of ARDS. Br J Anaesth 2006; 97:883-895.
32. Henzler D, Mahnken AH, Wildberger JE, et al. Multislice spiral computed tomography to determine the effects of a recruitment maneuver in experimental lung injury. Eur Radiol 2006; 16:1351-1359. In this study the effects of a recruitment maneuver on the morphology of lung parenchyma were analyzed experimentally by applying whole-lung CT scanning.
33. Markstaller K, Eberle B, Kauczor HU, et al. Temporal dynamics of lung aeration determined by dynamic CT in a porcine model of ARDS. Br J Anaesth 2001; 87:459-468.
34. David M, Karmrodt J, Bletz C, et al. Analysis of atelectasis, ventilated, and hyperinflated lung during mechanical ventilation by dynamic CT. Chest 2005; 128:3757-3770.
35. Victorino JA, Borges JB, Okamoto VN, et al. Imbalances in regional lung ventilation: a validation study on electrical impedance tomography. Am J Respir Crit Care Med 2004; 169:791-800.
36. Odenstedt H, Lindgren S, Olegard C, et al. Slowmoderate pressure recruitment maneuver minimizes negative circulatory and lung mechanic side effects: evaluation of recruitment maneuvers using electric impedance tomography. Intensive Care Med 2005; 31:1706-1714.
37. Schuster DP. Positron emission tomography: theory and its application to the study of lung disease. Am Rev Respir Dis 1989; 139:818-840.
38. Richter T, Bellani G, Scott HR, et al. Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury. Am J Respir Crit Care Med 2005; 172:480-487.
39. Venegas JG, Winkler T, Musch G, et al. Self-organized patchiness in asthma as a prelude to catastrophic shifts. Nature 2005; 434:777-782.
40. Harris RS, Schuster DP. Visualizing lung function with positron emission tomography. J Appl Physiol 2007; 102:448-458. This is an outstanding review on the mechanisms and advantages of applying PET analysis to study the pathophysiology of different lung diseases.
41. Rasanen J, Gavriely N. Detection of porcine oleic acid-induced acute lung injury using pulmonary acoustics. J Appl Physiol 2002; 93:51-57.
42. Rasanen J, Gavriely N. Response of acoustic transmission to positive airway pressure therapy in experimental lung injury. Intensive Care Med 2005; 31:1434-1441.