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Use of computed tomography scanning to guide lung recruitment and adjust positive-end expiratory pressure
- Source :
- Current Opinion in Critical Care. 17:268-274
- Publication Year :
- 2011
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2011.
-
Abstract
- Purpose of review We discuss the possible role of computed tomography (CT) to guide protective mechanical ventilation in acute lung injury/acute respiratory distress syndrome (ALI/ARDS), especially tidal volume (VT) and positive-end expiratory pressure (PEEP) settings and recruitment manoeuvres. Recent findings CT should be used as early as possible after the onset of ALI/ARDS and then repeated after 1 week in the absence of clinical improvement. Advantages of CT include: the regional response to recruitment can be determined; it is objective; the morphofunctional correlations obtained are useful for a comprehensive patient evaluation. CT should be performed at different pressure levels to identify potential for recruitment. Initially, one single whole-lung CT scan is performed at end-expiration at PEEP 5-10 cmH2O to evaluate aeration and compute lung weight. Afterwards, two lung CT slices are performed to assess lung recruitability (at PEEP = 5-10 cmH2O; inspiratory plateau pressure of the respiratory system = 45 cmH2O). Summary In ALI/ARDS patients, CT reveals discrepancies between bedside chest radiograph and various clinical and physiological parameters, and it is essential to assess lung morphology and recruitability. Specific algorithms, including or not CT, should be used to better identify ALI/ARDS with potential of recruitment and setting of VT and PEEP.
- Subjects :
- medicine.medical_specialty
ARDS
Ventilator-Induced Lung Injury
medicine.medical_treatment
Lung injury
Critical Care and Intensive Care Medicine
Positive-Pressure Respiration
Plateau pressure
Internal medicine
Tidal Volume
medicine
Humans
Positive end-expiratory pressure
Tidal volume
Mechanical ventilation
Respiratory Distress Syndrome
Lung
medicine.diagnostic_test
business.industry
respiratory system
medicine.disease
lung recruitment
respiratory tract diseases
Surgery
medicine.anatomical_structure
Cardiology
Tomography, X-Ray Computed
Chest radiograph
business
circulatory and respiratory physiology
Subjects
Details
- ISSN :
- 10705295
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- Current Opinion in Critical Care
- Accession number :
- edsair.doi.dedup.....d5a077eb1d939b478a7600d99cc3fd88