Acute lung injury/acute respiratory distress syndrome pathophysiology: What we have learned from computed tomography scanning

Current Opinion in Critical Care

Volumn 14, Issue 1, 2008, Pages 64-69

  Caironi, Pietro ^a   Langer, Thomas ^a   Gattinoni, Luciano ^a  

^a UNIVERSITY OF MILAN   (Italy)

Author keywords

Acute lung injury; Acute respiratory distress syndrome; Computed tomography; Positive end expiratory pressure; Ventilator induced lung injury

Indexed keywords

ACUTE LUNG INJURY; ADULT RESPIRATORY DISTRESS SYNDROME; BREATHING MECHANICS; COMPUTER ASSISTED IMPEDANCE TOMOGRAPHY; COMPUTER ASSISTED TOMOGRAPHY; ECHOGRAPHY; HUMAN; HYPERINFLATION; PATHOPHYSIOLOGY; POSITIVE END EXPIRATORY PRESSURE; REVIEW; TIDAL VOLUME;

HUMANS; RESPIRATION, ARTIFICIAL; RESPIRATORY DISTRESS SYNDROME, ADULT; TOMOGRAPHY, X-RAY COMPUTED;

EID: 38149007795     PISSN: 10705295     EISSN: 15317072     Source Type: Journal    
DOI: 10.1097/MCC.0b013e3282f42d8c     Document Type: Review

References (46)

1. 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.
2. 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.
3. Qureshi NR, Hien TT, Farrar J, et al. The radiologic manifestations of H5N1 avian influenza. J Thorac Imaging 2006; 21:259-264.
4. Raghu MG, Wig JD, Kochhar R, et al. Lung complications in acute pancreatitis. JOP 2007; 8:177-185.
5. D'Ignazio N, Iannuzzi M, Colella V, et al. Postraumatic ARDS: how to place patients who may offer technical problems in a prone position. Minerva Anestesiol 2007; 73:467-470.
6. Reske A, Seiwerts M, Reske A, et al. Early recovery from posttraumatic acute respiratory distress syndrome. Clin Physiol Funct Imaging 2006; 26:376-379.
7. Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. N Engl J Med 2005; 353:1685-1693.
8. Lewandowski K, Lewandowski M. Epidemiology of ARDS. Minerva Anestesiol 2006; 72:473-477.
9. 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.
10. Suarez-Sipmann F, Bohm SH, Tusman G, et al. Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study. Crit Care Med 2007; 35:214-221. Report on the continuous monitoring of dynamic compliance of the respiratory system as a tool to identify the beginning of lung collapse for PEEP setting.
11. Carvalho AR, Jandre FC, Pino AV, et al. Positive end-expiratory pressure at minimal respiratory elastance corresponds to the best compromise between mechanical stress and lung aeration in oleic acid-induced lung injury. Crit Care 2007; 11:R86. Interesting investigation reporting the use of respiratory system elastance during a decremental PEEP trial to individuate the level of pressure at which normal aeration is maximized, while lung collapse is minimized.
12. Bellardine Black CL, Hoffman AM, Tsai LW, et al. Relationship between dynamic respiratory mechanics and disease heterogeneity in sheep lavage injury. Crit Care Med 2007; 35:870-878. Important experimental proof of the feasibility of monitoring dynamic mechanics of the respiratory system to assess the trade-off between alveolar recruitment and hyperinflation while increasing PEEP.
13. Terragni PP, Rosboch G, Tealdi A, et al. Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med 2007; 175:160-166. Excellent study reporting the first evidence of the development of a high degree of lung hyperinflation even after the application of a low tidal volume strategy in patients characterized by a great amount of nonaerated lung tissue and a small portion of relatively 'healthy' lung.
14. Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet 1967; ii:319-323.
15. Falke KJ, Pontoppidan H, Kumar A, et al. Ventilation with end-expiratory pressure in acute lung disease. J Clin Invest 1972; 51:2315-2323.
16. Brower RG, Lanken PN, MacIntyre N, et al. Higher versus lower positive endexpiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004; 351:327-336.
17. Villar J. Low vs high positive end-expiratory pressure in the ventilatory management of acute lung injury. Minerva Anestesiol 2006; 72:357-362.
18. 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.
19. Caironi P, Gattinoni L. How to monitor lung recruitment in patients with acute lung injury. Curr Opin Crit Care 2007; 13:338-343.
20. Dueck R. Alveolar recruitment versus hyperinflation: a balancing act. Curr Opin Anaesthesiol 2006; 19:650-654. Interesting review on the contrasting effect of PEEP application on the lung parenchyma, in terms of alveolar recruitment and hyperinflation.
21. Crotti S, Mascheroni D, Caironi P, et al. Recruitment and derecruitment during acute respiratory failure: a clinical study. Am J Respir Crit Care Med 2001; 164:131-140.
22. Jeon K, Jeon IS, Suh GY, et al. Two methods of setting positive end-expiratory pressure in acute lung injury: an experimental computed tomography volumetric study. J Korean Med Sci 2007; 22:476-483. Interesting study highlighting the importance of setting PEEP during the deflation phase of the P/V curve rather than during lung inflation.
23. Chiumello D, Carlesso E, Aliverti A, et al. Effects of volume shift on the pressure-volume curve of the respiratory system in ALI/ARDS patients. Minerva Anestesiol 2007; 73:109-118.
24. Grasso S. Static pressure-volume curves of the respiratory system: worth keeping to measure them? Minerva Anestesiol 2007; 73:107-108.
25. Muscedere JG, Mullen JB, Gan K, et al. Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 1994; 149:1327-1334.
26. Ranieri VM, Suter PM, Tortorella C, et al. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA 1999; 282:54-61.
27. Dreyfuss D, Basset G, Soler P, et al. Intermittent positive-pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats. Am Rev Respir Dis 1985; 132:880-884.
28. Dreyfuss D, Soler P, Basset G, et al. High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 1988; 137:1159-1164.
29. Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 1998; 157:294-323.
30. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342:1301-1308.
31. Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998; 338:347-354.
32. Villar J, Kacmarek RM, Perez-Mendez L, et al. A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial. Crit Care Med 2006; 34:1311-1318.
33. Haitsma JJ, Lachmann B. Lung protective ventilation in ARDS: the open lung maneuver. Minerva Anestesiol 2006; 72:117-132.
34. Gattinoni L, Pesenti A. The concept of 'baby lung'. Intensive Care Med 2005; 31:776-784.
35. Kopp R, Dembinski R, Kuhlen R. Role of extracorporeal lung assist in the treatment of acute respiratory failure. Minerva Anestesiol 2006; 72:587-595.
36. 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. Report on experimental demonstrations of the 'collapse' origin of derecruitment, as compared to a fluid-filling process, in two different animal models of lung injury.
37. Hubmayr RD. Perspective on lung injury and recruitment: a skeptical look at the opening and collapse story. Am J Respir Crit Care Med 2002; 165:1647-1653.
38. Wurfel MM. Microarray-based analysis of ventilator-induced lung injury. Proc Am Thorac Soc 2007; 4:77-84.
39. Flores C, Ma SF, Maresso K, et al. Genomics of acute lung injury. Semin Respir Crit Care Med 2006; 27:389-395.
40. Simon BA, Easley RB, Grigoryev DN, et al. Microarray analysis of regional cellular responses to local mechanical stress in acute lung injury. Am J Physiol Lung Cell Mol Physiol 2006; 291:L851-L861. Very elegant investigation elucidating the different mechanisms and effects of VILI on different anatomical lung regions, both in terms of functional lung morphology and gene up/downregulation.
41. Gattinoni L, Caironi P, Pelosi P, et al. What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 2001; 164:1701-1711.
42. Putensen C, Wrigge H, Zinserling J. Electrical impedance tomography guided ventilation therapy. Curr Opin Crit Care 2007; 13:344-350. Extensive review on the characteristics, advantages and limitations of electrical impedance tomography for a bedside study of lung ventilation during lung injury.
43. Musch G, Venegas JG. Positron emission tomography imaging of regional lung function. Minerva Anestesiol 2006; 72:363-367.
44. Frerichs I, Hinz J, Herrmann P, et al. Detection of local lung air content by electrical impedance tomography compared with electron beam CT. J Appl Physiol 2002; 93:660-666.
45. 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.
46. Bouhemad B, Zhang M, Lu Q, et al. Clinical review: bedside lung ultrasound in critical care practice. Crit Care 2007; 11:205. Interesting review of the potential clinical application of lung ultrasound as an alternative technique available at the bedside for monitoring lung imaging and functionality.