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The Effect of Positive End-Expiratory Pressure on Lung Micromechanics Assessed by Synchrotron Radiation Computed Tomography in an Animal Model of ARDS
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Ferrara Univ, Dept Morphol Surg & Expt Med, I-44121 Ferrara, Italy;.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.ORCID iD: 0000-0001-5668-7399
Univ Helsinki, Dept Phys, FI-00014 Helsinki, Finland;Helsinki Univ Hosp, FI-00029 Helsinki, Finland.ORCID iD: 0000-0003-3639-944X
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2019 (English)In: JOURNAL OF CLINICAL MEDICINE, ISSN 2077-0383, Vol. 8, no 8, article id 1117Article in journal (Refereed) Published
Abstract [en]

Modern ventilatory strategies are based on the assumption that lung terminal airspaces act as isotropic balloons that progressively accommodate gas. Phase contrast synchrotron radiation computed tomography (PCSRCT) has recently challenged this concept, showing that in healthy lungs, deflation mechanisms are based on the sequential de-recruitment of airspaces. Using PCSRCT scans in an animal model of acute respiratory distress syndrome (ARDS), this study examined whether the numerosity (ASnum) and dimension (ASdim) of lung airspaces change during a deflation maneuver at decreasing levels of positive end-expiratory pressure (PEEP) at 12, 9, 6, 3, and 0 cmH(2)O. Deflation was associated with significant reduction of ASdim both in the whole lung section (passing from from 13.1 +/- 2.0 at PEEP 12 to 7.6 +/- 4.2 voxels at PEEP 0) and in single concentric regions of interest (ROIs). However, the regression between applied PEEP and ASnum was significant in the whole slice (ranging from 188 +/- 52 at PEEP 12 to 146.4 +/- 96.7 at PEEP 0) but not in the single ROIs. This mechanism of deflation in which reduction of ASdim is predominant, differs from the one observed in healthy conditions, suggesting that the peculiar alveolar micromechanics of ARDS might play a role in the deflation process.

Place, publisher, year, edition, pages
MDPI , 2019. Vol. 8, no 8, article id 1117
Keywords [en]
ARDS, recruitment, VILI, alveoli, kinetics, synchrotron radiation computed tomography
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-394162DOI: 10.3390/jcm8081117ISI: 000483737700125PubMedID: 31357677OAI: oai:DiVA.org:uu-394162DiVA, id: diva2:1359393
Funder
Swedish Research Council, K2015-99X-22731-01-4Available from: 2019-10-09 Created: 2019-10-09 Last updated: 2019-10-09Bibliographically approved

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Scaramuzzo, GaetanoPellegrini, MariangelaPorra, LiisaBravin, Alberto
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