Hysteresis and Lung Recruitment in Acute Respiratory Distress Syndrome Patients: A CT Scan Study.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
pubmed:
9
9
2020
medline:
26
5
2021
entrez:
8
9
2020
Statut:
ppublish
Résumé
Hysteresis of the respiratory system pressure-volume curve is related to alveolar surface forces, lung stress relaxation, and tidal reexpansion/collapse. Hysteresis has been suggested as a means of assessing lung recruitment. The objective of this study was to determine the relationship between hysteresis, mechanical characteristics of the respiratory system, and lung recruitment assessed by a CT scan in mechanically ventilated acute respiratory distress syndrome patients. Prospective observational study. General ICU of a university hospital. Twenty-five consecutive sedated and paralyzed patients with acute respiratory distress syndrome (age 64 ± 15 yr, body mass index 26 ± 6 kg/m, PaO2/FIO2 147 ± 42, and positive end-expiratory pressure 9.3 ± 1.4 cm H2O) were enrolled. A low-flow inflation and deflation pressure-volume curve (5-45 cm H2O) and a sustained inflation recruitment maneuver (45 cm H2O for 30 s) were performed. A lung CT scan was performed during breath-holding pressure at 5 cm H2O and during the recruitment maneuver at 45 cm H2O. Lung recruitment was computed as the difference in noninflated tissue and in gas volume measured at 5 and at 45 cm H2O. Hysteresis was calculated as the ratio of the area enclosed by the pressure-volume curve and expressed as the hysteresis ratio. Hysteresis was correlated with respiratory system compliance computed at 5 cm H2O and the lung gas volume entering the lung during inflation of the pressure-volume curve (R = 0.749, p < 0.001 and R = 0.851, p < 0.001). The hysteresis ratio was related to both lung tissue and gas recruitment (R = 0.266, p = 0.008, R = 0.357, p = 0.002, respectively). Receiver operating characteristic analysis showed that the optimal cutoff value to predict lung tissue recruitment for the hysteresis ratio was 28% (area under the receiver operating characteristic curve, 0.80; 95% CI, 0.62-0.98), with sensitivity and specificity of 0.75 and 0.77, respectively. Hysteresis of the respiratory system computed by low-flow pressure-volume curve is related to the anatomical lung characteristics and has an acceptable accuracy to predict lung recruitment.
Identifiants
pubmed: 32897667
doi: 10.1097/CCM.0000000000004518
pii: 00003246-202010000-00012
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1494-1502Commentaires et corrections
Type : CommentIn
Type : ErratumIn
Type : CommentIn
Références
Thompson BT, Chambers RC, Liu KD. Acute respiratory distress syndrome. N Engl J Med 2017; 377:1904–1905
Cressoni M, Chiumello D, Chiurazzi C, et al. Lung inhomogeneities, inflation and [18F]2-fluoro-2-deoxy-D-glucose uptake rate in acute respiratory distress syndrome. Eur Respir J 2016; 47:233–242
Umbrello M, Formenti P, Bolgiaghi L, et al. Current concepts of ARDS: A narrative review. Int J Mol Sci 2016; 18:64
Lachmann B. Open up the lung and keep the lung open. Intensive Care Med 1992; 18:319–321
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
Chiumello D, Froio S, Bouhemad B, et al. Clinical review: Lung imaging in acute respiratory distress syndrome patients–an update. Crit Care 2013; 17:243
Chiumello D, Marino A, Brioni M, et al. Lung recruitment assessed by respiratory mechanics and computed tomography in patients with acute respiratory distress syndrome. What is the relationship? Am J Respir Crit Care Med 2016; 193:1254–1263
Papazian L, Calfee CS, Chiumello D, et al. Diagnostic workup for ARDS patients. Intensive Care Med 2016; 42:674–685
Maggiore SM, Richard JC, Brochard L. What has been learnt from P/V curves in patients with acute lung injury/acute respiratory distress syndrome. Eur Respir J Suppl 2003; 42:22s–26s
Rouby JJ, Lu Q, Vieira S. Pressure/volume curves and lung computed tomography in acute respiratory distress syndrome. Eur Respir J Suppl 2003; 42:27s–36s
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
Harris RS. Pressure-volume curves of the respiratory system. Respir Care 2005; 50:78–98; discussion 98–99
Lu Q, Vieira SR, Richecoeur J, et al. A simple automated method for measuring pressure-volume curves during mechanical ventilation. Am J Respir Crit Care Med 1999; 159:275–282
Mankikian B, Lemaire F, Benito S, et al. A new device for measurement of pulmonary pressure-volume curves in patients on mechanical ventilation. Crit Care Med 1983; 11:897–901
Fedullo AJ, Jung-Legg Y, Snider GL, et al. Hysteresis ratio: A measure of the mechanical efficiency of fibrotic and emphysematous hamster lung tissue. Am Rev Respir Dis 1980; 122:47–52
Escolar JD, Escolar A. Lung hysteresis: A morphological view. Histol Histopathol 2004; 19:159–166
Mead J, Whittenberger JL, Radford EP Jr. Surface tension as a factor in pulmonary volume-pressure hysteresis. J Appl Physiol 1957; 10:191–196
Bachofen H, Hildebrandt J. Area analysis of pressure-volume hysteresis in mammalian lungs. J Appl Physiol 1971; 30:493–497
Matamis D, Lemaire F, Harf A, et al. Total respiratory pressure-volume curves in the adult respiratory distress syndrome. Chest 1984; 86:58–66
Demory D, Arnal JM, Wysocki M, et al. Recruitability of the lung estimated by the pressure volume curve hysteresis in ARDS patients. Intensive Care Med 2008; 34:2019–2025
Henzler D, Hochhausen N, Dembinski R, et al. Parameters derived from the pulmonary pressure volume curve, but not the pressure time curve, indicate recruitment in experimental lung injury. Anesth Analg 2007; 105:1072–1078, table of contents
Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: The Berlin definition. JAMA 2012; 307:2526–2533
Arnal JM, Paquet J, Wysocki M, et al. Optimal duration of a sustained inflation recruitment maneuver in ARDS patients. Intensive Care Med 2011; 37:1588–1594
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
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
Dall’ava-Santucci J, Armaganidis A, Brunet F, et al. Causes of error of respiratory pressure-volume curves in paralyzed subjects. J Appl Physiol 1988; 64:42–49
Gattinoni L, Mascheroni D, Basilico E, et al. Volume/pressure curve of total respiratory system in paralysed patients: Artefacts and correction factors. Intensive Care Med 1987; 13:19–25
Umbrello M, Chiumello D. Interpretation of the transpulmonary pressure in the critically ill patient. Ann Transl Med 2018; 6:383
Roupie E, Dambrosio M, Servillo G, et al. Titration of tidal volume and induced hypercapnia in acute respiratory distress syndrome. Am J Respir Crit Care Med 1995; 152:121–128
Chen L, Del Sorbo L, Grieco DL, et al. Potential for lung recruitment estimated by the recruitment-to-inflation ratio in acute respiratory distress syndrome. A clinical trial. Am J Respir Crit Care Med 2020; 201:178–187
Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143:29–36
Chiumello D, Guérin C. Understanding the setting of PEEP from esophageal pressure in patients with ARDS. Intensive Care Med 2015; 41:1465–1467
Richard JC, Maggiore SM, Mercat A. Clinical review: Bedside assessment of alveolar recruitment. Crit Care 2004; 8:163–169
Gattinoni L, Pesenti A, Avalli L, et al. Pressure-volume curve of total respiratory system in acute respiratory failure. Computed tomographic scan study. Am Rev Respir Dis 1987; 136:730–736
Gattinoni L, Pesenti A, Bombino M, et al. Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology 1988; 69:824–832
Cressoni M, Chiumello D, Carlesso E, et al. Compressive forces and computed tomography-derived positive end-expiratory pressure in acute respiratory distress syndrome. Anesthesiology 2014; 121:572–581
Chiumello D, Cressoni M, Carlesso E, et al. Bedside selection of positive end-expiratory pressure in mild, moderate, and severe acute respiratory distress syndrome. Crit Care Med 2014; 42:252–264
Yun L, He HW, Möller K, et al. Assessment of lung recruitment by electrical impedance tomography and oxygenation in ARDS patients. Medicine (Baltimore) 2016; 95:e3820
Karbing DS, Panigada M, Bottino N, et al. Changes in shunt, ventilation/perfusion mismatch, and lung aeration with PEEP in patients with ARDS: A prospective single-arm interventional study. Crit Care 2020; 24:111
Rouby JJ, Puybasset L, Nieszkowska A, et al. Acute respiratory distress syndrome: Lessons from computed tomography of the whole lung. Crit Care Med 2003; 31:S285–S295
Beydon L, Svantesson C, Brauer K, et al. Respiratory mechanics in patients ventilated for critical lung disease. Eur Respir J 1996; 9:262–273
Rimensberger PC, Cox PN, Frndova H, et al. The open lung during small tidal volume ventilation: Concepts of recruitment and “optimal” positive end-expiratory pressure. Crit Care Med 1999; 27:1946–1952
Bitzén U, Drefeldt B, Niklason L, et al. Dynamic elastic pressure-volume loops in healthy pigs recorded with inspiratory and expiratory sinusoidal flow modulation. Relationship to static pressure-volume loops. Intensive Care Med 2004; 30:481–488
Benito S, Lemaire F, Mankikian B, et al. Total respiratory compliance as a function of lung volume in patients with mechanical ventilation. Intensive Care Med 1985; 11:76–79
Holzapfel L, Robert D, Perrin F, et al. Static pressure-volume curves and effect of positive end-expiratory pressure on gas exchange in adult respiratory distress syndrome. Crit Care Med 1983; 11:591–597
Koefoed-Nielsen J, Nielsen ND, Kjaergaard AJ, et al. Alveolar recruitment can be predicted from airway pressure-lung volume loops: An experimental study in a porcine acute lung injury model. Crit Care 2008; 12:R7
Scaramuzzo G, Broche L, Pellegrini M, et al. The effect of positive end-expiratory pressure on lung micromechanics assessed by synchrotron radiation computed tomography in an animal model of ARDS. J Clin Med 2019; 8:1117
Ranieri VM, Giuliani R, Fiore T, et al. Volume-pressure curve of the respiratory system predicts effects of PEEP in ARDS: “occlusion” versus “constant flow” technique. Am J Respir Crit Care Med 1994; 149:19–27
Adams AB, Cakar N, Marini JJ. Static and dynamic pressure-volume curves reflect different aspects of respiratory system mechanics in experimental acute respiratory distress syndrome. Respir Care 2001; 46:686–693
Jabaudon M, Blondonnet R, Audard J, et al. Recent directions in personalised acute respiratory distress syndrome medicine. Anaesth Crit Care Pain Med 2018; 37:251–258
Puybasset L, Gusman P, Muller JC, et al. Regional distribution of gas and tissue in acute respiratory distress syndrome. III. Consequences for the effects of positive end-expiratory pressure. CT Scan ARDS Study Group. Adult Respiratory Distress Syndrome. Intensive Care Med 2000; 26:1215–1227
Constantin JM, Jabaudon M, Lefrant JY, et al.; AZUREA Network: Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): A multicentre, single-blind, randomised controlled trial. Lancet Respir Med 2019; 7:870–880
Camporota L, Caricola EV, Bartolomeo N, et al. Lung recruitability in severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Crit Care Med 2019; 47:1177–1183