Document Detail

Evaluation of Recruited Lung Volume at Plateau Inspiratory Pressure With Positive End-Expiratory Pressure Using Bedside Digital Chest X-Ray in Acute Lung Injury/Acute Respiratory Distress Syndrome patients.
MedLine Citation:
PMID:  22906639     Owner:  NLM     Status:  Publisher    
BACKGROUND: We wanted to assess whether there was a significant relationship between recruited lung volume (Vrec) and change in density on digital processed chest X-ray measured at 2 different levels of Plateau-Inspiratory Pressure corresponding to 2 Positive End-Expiratory Pressure (PEEP) levels in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). METHODS: In 14 patients, PEEP 5 and 15 cm H₂O were prospectively applied in a random order for 10 minutes. At the end of each period, chest X-ray was taken using a digital portable device and volume-pressure curve of the respiratory system (VP curve) was performed. We also assessed PaO₂, static (Cst,rs) and dynamic compliance (Cdyn,rs) of respiratory system. Change in end-expiratory lung volume between tidal breath and relaxation volume of respiratory system was determined. Radiological attenuation was measured on chest-X-rays in 4 regions of interest in rightlung and in 3 regions of interest in left lung drawn in posterior intercostal spaces from top to bottomby using dedicated software. Ratio of lung density in each region between PEEP 15 and PEEP 5 (rP15/P5) and their arithmetic mean (mP15/P5) were computed. Vrec was determined from VP curves. RESULTS: Median value of rP15/P5 in the 98 lung levels was 0.91 (0.80-1.01) (P<.0001 vs. 1). Values of rP15/P5 were not significantly different between lung levels. Median values of Vrec and mP15/P5 were 288 (173-402) mL and 0.90 (0.80-0.97), respectively. There was a significant negative correlation between Vrec and mP15/P5 (R=-0.77, P=.01). The reduction in mP15/P5 tended to correlate with the increase in Cdyn,rs (R=-0.49, P=.077) or in PaO₂ (R=-0.53, P=.05) between PEEP 15 and PEEP 5 cm H₂O. CONCLUSIONS: Digital chest X-ray done at the bedside in ALI/ARDS patients was able to detect a reduction in density between PEEP 5 and PEEP 15 cmH₂O that correlated with Vrec.
F Wallet; B Delannoy; A Haquin; S Debord; V Leray; G Bourdin; F Bayle; Jc Richard; L Boussel; C Guérin
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-16
Journal Detail:
Title:  Respiratory care     Volume:  -     ISSN:  0020-1324     ISO Abbreviation:  Respir Care     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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