We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Lung regional metabolic activity and gas volume changes induced by tidal ventilation in patients with acute lung injury.
- Authors
Bellani G; Guerra L; Musch G; Zanella A; Patroniti N; Mauri T; Messa C; Pesenti A; Bellani, Giacomo; Guerra, Luca; Musch, Guido; Zanella, Alberto; Patroniti, Nicolò; Mauri, Tommaso; Messa, Cristina; Pesenti, Antonio
- Abstract
<bold>Rationale: </bold>During acute lung injury (ALI), mechanical ventilation can aggravate inflammation by promoting alveolar distension and cyclic recruitment-derecruitment. As an estimate of the intensity of inflammation, metabolic activity can be measured by positron emission tomography imaging of [(18)F]fluoro-2-deoxy-D-glucose.<bold>Objectives: </bold>To assess the relationship between gas volume changes induced by tidal ventilation and pulmonary metabolic activity in patients with ALI.<bold>Methods: </bold>In 13 mechanically ventilated patients with ALI and relatively high positive end-expiratory pressure, we performed a positron emission tomography scan of the chest and three computed tomography scans: at mean airway pressure, end-expiration, and end-inspiration. Metabolic activity was measured from the [(18)F]fluoro-2-deoxy-D-glucose uptake rate. The computed tomography scans were used to classify lung regions as derecruited throughout the respiratory cycle, undergoing recruitment-derecruitment, and normally aerated.<bold>Measurements and Main Results: </bold>Metabolic activity of normally aerated lung was positively correlated both with plateau pressure, showing a pronounced increase above 26 to 27 cm H(2)O, and with regional Vt normalized by end-expiratory lung gas volume. This relationship did not appear to be caused by a higher underlying parenchymal metabolic activity in patients with higher plateau pressure. Regions undergoing cyclic recruitment-derecruitment did not have higher metabolic activity than those collapsed throughout the respiratory cycle.<bold>Conclusions: </bold>In patients with ALI managed with relatively high end-expiratory pressure, metabolic activity of aerated regions was associated with both plateau pressure and regional Vt normalized by end-expiratory lung gas volume, whereas no association was found between cyclic recruitment-derecruitment and increased metabolic activity.
- Publication
American Journal of Respiratory & Critical Care Medicine, 2011, Vol 183, Issue 9, p1193
- ISSN
1073-449X
- Publication type
journal article
- DOI
10.1164/rccm.201008-1318OC