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Santos A, Motta-Ribeiro GC, de Prost N, Tucci MR, Wellman TJ, Vidal Melo MF, Winkler T. Regional pulmonary perfusion, blood volume, and their relationship change in experimental early ARDS. Sci Rep 2024; 14:5832. [PMID: 38461172 PMCID: PMC10925058 DOI: 10.1038/s41598-024-56565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/08/2024] [Indexed: 03/11/2024] Open
Abstract
Regional pulmonary perfusion (Q) has been investigated using blood volume (Fb) imaging as an easier-to-measure surrogate. However, it is unclear if changing pulmonary conditions could affect their relationship. We hypothesized that vascular changes in early acute respiratory distress syndrome (ARDS) affect Q and Fb differently. Five sheep were anesthetized and received lung protective mechanical ventilation for 20 h while endotoxin was continuously infused. Using dynamic 18F-FDG and 13NN Positron Emission Tomography (PET), regional Fb and Q were analysed in 30 regions of interest (ROIs) and normalized by tissue content (Fbn and Qn, respectively). After 20 h, the lung injury showed characteristics of early ARDS, including gas exchange and lung mechanics. PET images of Fbn and Qn showed substantial differences between baseline and lung injury. Lung injury caused a significant change in the Fbn-Qn relationship compared to baseline (p < 0.001). The best models at baseline and lung injury were Fbn = 0.32 + 0.690Qn and Fbn = 1.684Qn-0.538Qn2, respectively. Endotoxine-associated early ARDS changed the relationship between Fb and Q, shifting from linear to curvilinear. Effects of endotoxin exposure on the vasoactive blood flow regulation were most likely the key factor for this change limiting the quantitative accuracy of Fb imaging as a surrogate for regional Q.
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Affiliation(s)
- Arnoldo Santos
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
- CIBER de enfermedades respiratorias CIBERES ISCIII, Madrid, Spain
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gabriel C Motta-Ribeiro
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Biomedical Engineering Program, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nicolas de Prost
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Medical Intensive Care Unit, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Mauro R Tucci
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao, Hospital Das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Tyler J Wellman
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- GE Healthcare, Ultrasound Digital Solutions, San Mateo, CA, USA
| | - Marcos F Vidal Melo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th St., PH 5-505, New York, NY, 10032, USA
| | - Tilo Winkler
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Escalona J, Soto D, Oviedo V, Rivas E, Severino N, Kattan E, Andresen M, Bravo S, Basoalto R, Bachmann MC, Wong KY, Pavez N, Bruhn A, Bugedo G, Retamal J. Beta-Lactam Antibiotics Can Be Measured in the Exhaled Breath Condensate in Mechanically Ventilated Patients: A Pilot Study. J Pers Med 2023; 13:1146. [PMID: 37511759 PMCID: PMC10381781 DOI: 10.3390/jpm13071146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Different techniques have been proposed to measure antibiotic levels within the lung parenchyma; however, their use is limited because they are invasive and associated with adverse effects. We explore whether beta-lactam antibiotics could be measured in exhaled breath condensate collected from heat and moisture exchange filters (HMEFs) and correlated with the concentration of antibiotics measured from bronchoalveolar lavage (BAL). We designed an observational study in patients undergoing mechanical ventilation, which required a BAL to confirm or discard the diagnosis of pneumonia. We measured and correlated the concentration of beta-lactam antibiotics in plasma, epithelial lining fluid (ELF), and exhaled breath condensate collected from HMEFs. We studied 12 patients, and we detected the presence of antibiotics in plasma, ELF, and HMEFs from every patient studied. The concentrations of antibiotics were very heterogeneous over the population studied. The mean antibiotic concentration was 293.5 (715) ng/mL in plasma, 12.3 (31) ng/mL in ELF, and 0.5 (0.9) ng/mL in HMEF. We found no significant correlation between the concentration of antibiotics in plasma and ELF (R2 = 0.02, p = 0.64), between plasma and HMEF (R2 = 0.02, p = 0.63), or between ELF and HMEF (R2 = 0.02, p = 0.66). We conclude that beta-lactam antibiotics can be detected and measured from the exhaled breath condensate accumulated in the HMEF from mechanically ventilated patients. However, no correlations were observed between the antibiotic concentrations in HMEF with either plasma or ELF.
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Affiliation(s)
- José Escalona
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Unidad de Paciente Crítico, Hospital El Salvador, Santiago 8331150, Chile
| | - Dagoberto Soto
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Vanessa Oviedo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Elizabeth Rivas
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Nicolás Severino
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Programa de Farmacología y Toxicología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Max Andresen
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Sebastián Bravo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Roque Basoalto
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Programa de Medicina Física y Rehabilitación, Red Salud UC-CHRISTUS, Santiago 8331150, Chile
| | - María Consuelo Bachmann
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Kwok-Yin Wong
- State Key Laboratory of Chemical Biology and Drug Discovery, Department of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, Kowloon 999077, Hong Kong
| | - Nicolás Pavez
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Departamento de Medicina Interna, Facultad de Medicina, Universidad de Concepción, Concepción 4030000, Chile
| | - Alejandro Bruhn
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Guillermo Bugedo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
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Wang Y, Spencer BA, Schmall J, Li E, Badawi RD, Jones T, Cherry SR, Wang G. High-Temporal-Resolution Lung Kinetic Modeling Using Total-Body Dynamic PET with Time-Delay and Dispersion Corrections. J Nucl Med 2023; 64:1154-1161. [PMID: 37116916 PMCID: PMC10315691 DOI: 10.2967/jnumed.122.264810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/22/2023] [Indexed: 04/30/2023] Open
Abstract
Tracer kinetic modeling in dynamic PET has the potential to improve the diagnosis, prognosis, and research of lung diseases. The advent of total-body PET systems with much greater detection sensitivity enables high-temporal-resolution (HTR) dynamic PET imaging of the lungs. However, existing models may become insufficient for modeling the HTR data. In this paper, we investigate the necessity of additional corrections to the input function for HTR lung kinetic modeling. Methods: Dynamic scans with HTR frames of as short as 1 s were performed on 13 healthy subjects with a bolus injection of about [Formula: see text] of 18F-FDG using the uEXPLORER total-body PET/CT system. Three kinetic models with and without time-delay and dispersion corrections were compared for the quality of lung time-activity curve fitting using the Akaike information criterion. The impact on quantification of 18F-FDG delivery rate [Formula: see text], net influx rate [Formula: see text] and fractional blood volume [Formula: see text] was assessed. Parameter identifiability analysis was also performed to evaluate the reliability of kinetic quantification with respect to noise. Correlation of kinetic parameters with age was investigated. Results: HTR dynamic imaging clearly revealed the rapid change in tracer concentration in the lungs and blood supply (i.e., the right ventricle). The uncorrected input function led to poor time-activity curve fitting and biased quantification in HTR kinetic modeling. The fitting was improved by time-delay and dispersion corrections. The proposed model resulted in an approximately 85% decrease in [Formula: see text], an approximately 75% increase in [Formula: see text], and a more reasonable [Formula: see text] (∼0.14) than the uncorrected model (∼0.04). The identifiability analysis showed that the proposed models had good quantification stability for [Formula: see text], [Formula: see text], and [Formula: see text] The [Formula: see text] estimated by the proposed model with simultaneous time-delay and dispersion corrections correlated inversely with age, as would be expected. Conclusion: Corrections to the input function are important for accurate lung kinetic analysis of HTR dynamic PET data. The modeling of both delay and dispersion can improve model fitting and significantly impact quantification of [Formula: see text], [Formula: see text], and [Formula: see text].
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Affiliation(s)
- Yiran Wang
- Department of Radiology, University of California Davis Medical Center, Sacramento, California;
- Department of Biomedical Engineering, University of California at Davis, Davis, California; and
| | - Benjamin A Spencer
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
- Department of Biomedical Engineering, University of California at Davis, Davis, California; and
| | | | - Elizabeth Li
- Department of Biomedical Engineering, University of California at Davis, Davis, California; and
| | - Ramsey D Badawi
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
- Department of Biomedical Engineering, University of California at Davis, Davis, California; and
| | - Terry Jones
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
| | - Simon R Cherry
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
- Department of Biomedical Engineering, University of California at Davis, Davis, California; and
| | - Guobao Wang
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
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Musch G. Molecular imaging of inflammation with PET in acute and ventilator-induced lung injury. Front Physiol 2023; 14:1177717. [PMID: 37457026 PMCID: PMC10338917 DOI: 10.3389/fphys.2023.1177717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
This review focuses on methods to image acute lung inflammation with Positron Emission Tomography (PET). Four approaches are discussed that differ for biologic function of the PET reporter probe, radiotracer employed, and the specific aspect of the inflammatory response that is targeted. 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) is an enzyme substrate whose uptake is used to measure the metabolic activation of inflammatory cells during acute lung injury in the noncancerous lung. H2 15O and radiolabeled plasma proteins are inert molecules with the same physical characteristics as their nonradioactive counterparts and are used to measure edema and vascular permeability. Tagged enzyme or receptor inhibitors are used to probe expression of these targets induced by inflammatory stimuli. Lastly, cell-specific tracers are being developed to differentiate the cell types that contribute to the inflammatory response. Taken together, these methods cast PET imaging as a versatile and quantitative tool to measure inflammation in vivo noninvasively during acute and ventilator-induced lung injury.
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Proteomics of lung tissue reveals differences in inflammation and alveolar-capillary barrier response between atelectasis and aerated regions. Sci Rep 2022; 12:7065. [PMID: 35487970 PMCID: PMC9053128 DOI: 10.1038/s41598-022-11045-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
Atelectasis is a frequent clinical condition, yet knowledge is limited and controversial on its biological contribution towards lung injury. We assessed the regional proteomics of atelectatic versus normally-aerated lung tissue to test the hypothesis that immune and alveolar-capillary barrier functions are compromised by purely atelectasis and dysregulated by additional systemic inflammation (lipopolysaccharide, LPS). Without LPS, 130 proteins were differentially abundant in atelectasis versus aerated lung, mostly (n = 126) with less abundance together with negatively enriched processes in immune, endothelial and epithelial function, and Hippo signaling pathway. Instead, LPS-exposed atelectasis produced 174 differentially abundant proteins, mostly (n = 108) increased including acute lung injury marker RAGE and chemokine CCL5. Functional analysis indicated enhanced leukocyte processes and negatively enriched cell-matrix adhesion and cell junction assembly with LPS. Additionally, extracellular matrix organization and TGF-β signaling were negatively enriched in atelectasis with decreased adhesive glycoprotein THBS1 regardless of LPS. Concordance of a subset of transcriptomics and proteomics revealed overlap of leukocyte-related gene-protein pairs and processes. Together, proteomics of exclusively atelectasis indicates decreased immune response, which converts into an increased response with LPS. Alveolar-capillary barrier function-related proteomics response is down-regulated in atelectasis irrespective of LPS. Specific proteomics signatures suggest biological mechanistic and therapeutic targets for atelectasis-associated lung injury.
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Colleluori G, Graciotti L, Pesaresi M, Di Vincenzo A, Perugini J, Di Mercurio E, Caucci S, Bagnarelli P, Zingaretti CM, Nisoli E, Menzo S, Tagliabracci A, Ladoux A, Dani C, Giordano A, Cinti S. Visceral fat inflammation and fat embolism are associated with lung’s lipidic hyaline membranes in subjects with COVID-19. Int J Obes (Lond) 2022; 46:1009-1017. [PMID: 35082385 PMCID: PMC8790008 DOI: 10.1038/s41366-022-01071-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 12/15/2022]
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Quintanilla E, Diwa K, Nguyen A, Vu L, Toby IT. A Data Report on the Curation and Development of a Database of Genes for Acute Respiratory Distress Syndrome. Front Genet 2021; 12:750568. [PMID: 34956316 PMCID: PMC8700230 DOI: 10.3389/fgene.2021.750568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/17/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Erick Quintanilla
- University of Dallas, Department of Biology, Irving, TX, United States
| | - Kimberly Diwa
- University of Dallas, Department of Biology, Irving, TX, United States
| | - Ashley Nguyen
- University of Dallas, Department of Biology, Irving, TX, United States
| | - Lavang Vu
- University of Dallas, Department of Biology, Irving, TX, United States
| | - Inimary T Toby
- University of Dallas, Department of Biology, Irving, TX, United States
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8
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Musch G. New Frontiers in Functional and Molecular Imaging of the Acutely Injured Lung: Pathophysiological Insights and Research Applications. Front Physiol 2021; 12:762688. [PMID: 34955883 PMCID: PMC8696200 DOI: 10.3389/fphys.2021.762688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
This review focuses on the advances in the understanding of the pathophysiology of ventilator-induced and acute lung injury that have been afforded by technological development of imaging methods over the last decades. Examples of such advances include the establishment of regional lung mechanical strain as a determinant of ventilator-induced lung injury, the relationship between alveolar recruitment and overdistension, the regional vs. diffuse nature of pulmonary involvement in acute respiratory distress syndrome (ARDS), the identification of the physiological determinants of the response to recruitment interventions, and the pathophysiological significance of metabolic alterations in the acutely injured lung. Taken together, these advances portray multimodality imaging as the next frontier to both advance knowledge of the pathophysiology of these conditions and to tailor treatment to the individual patient's condition.
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Affiliation(s)
- Guido Musch
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical School, Worcester, MA, United States
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Maracaja L, Khanna AK, Royster R, Maracaja D, Lane M, Jordan JE. Selective Lobe Ventilation and a Novel Platform for Pulmonary Drug Delivery. J Cardiothorac Vasc Anesth 2021; 35:3416-3422. [PMID: 34103214 PMCID: PMC8095071 DOI: 10.1053/j.jvca.2021.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/18/2021] [Accepted: 04/24/2021] [Indexed: 11/17/2022]
Abstract
The current methods of mechanical ventilation and pulmonary drug delivery do not account for the heterogeneity of acute respiratory distress syndrome or its dependence on gravity. The severe lung disease caused by severe acute respiratory distress syndrome coronavirus 2, coronavirus disease 2019, is one of the many causes of acute respiratory distress syndrome. Severe acute respiratory distress syndrome coronavirus 2 has caused more than three million deaths worldwide and has challenged all therapeutic options for mechanical ventilation. Thus, new therapies are necessary to prevent deaths and long-term complications of severe lung diseases and prolonged mechanical ventilation. The authors of the present report have developed a novel device that allows selective lobe ventilation and selective lobe recruitment and provides a new platform for pulmonary drug delivery. A major advantage of separating lobes that are mechanically heterogeneous is to allow for customization of ventilator parameters to match the needs of segments with similar compliance, a better overall ventilation perfusion relationship, and prevention of ventilator-induced lung injury of more compliant lobes. This device accounts for lung heterogeneity and is a potential new therapy for acute lung injury by allowing selective lobe mechanical ventilation using two novel modes of mechanical ventilation (differential positive end-expiratory pressure and asynchronous ventilation), and two new modalities of alveolar recruitment (selective lobe recruitment and continuous positive airway pressure of lower lobes with continuous ventilation of upper lobes). Herein the authors report their initial experience with this novel device, including a brief overview of device development; the initial in vitro, ex vivo, and in vivo testing; layout of future research; potential benefits and new therapies; and expected challenges before its uniform implementation into clinical practice.
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Affiliation(s)
- Luiz Maracaja
- Department of Anesthesiology, Wake Forest Baptist Medical Center, Wake Forest University, Winston-Salem, NC.
| | - Ashish K Khanna
- Department of Anesthesiology, Wake Forest Baptist Medical Center, Wake Forest University, Winston-Salem, NC
| | - Roger Royster
- Department of Anesthesiology, Wake Forest Baptist Medical Center, Wake Forest University, Winston-Salem, NC
| | - Danielle Maracaja
- Department of Pathology, Wake Forest Baptist Medical Center, Wake Forest University, Winston-Salem, NC
| | - Magan Lane
- Department of Cardiothoracic Surgery, Wake Forest Baptist Medical Center, Wake Forest University, Winston-Salem, NC
| | - James Eric Jordan
- Department of Cardiothoracic Surgery, Wake Forest Baptist Medical Center, Wake Forest University, Winston-Salem, NC
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Beda A, Winkler T, Wellman TJ, De Prost N, Tucci M, Melo MFV. Physiological mechanism and spatial distribution of increased alveolar dead-space in early ARDS: An experimental study. Acta Anaesthesiol Scand 2021; 65:100-108. [PMID: 32931610 PMCID: PMC9846860 DOI: 10.1111/aas.13702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/03/2020] [Accepted: 08/25/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND We aimed to investigate the physiological mechanism and spatial distribution of increased physiological dead-space, an early marker of ARDS mortality, in the initial stages of ARDS. We hypothesized that: increased dead-space results from the spatial redistribution of pulmonary perfusion, not ventilation; such redistribution is not related to thromboembolism (ie, areas with perfusion = 0 and infinite ventilation-perfusion ratio, V ˙ / Q ˙ ), but rather to moderate shifts of perfusion increasing V ˙ / Q ˙ in non-dependent regions. METHODS Five healthy anesthetized sheep received protective ventilation for 20 hours, while endotoxin was continuously infused. Maps of voxel-level lung ventilation, perfusion, V ˙ / Q ˙ , CO2 partial pressures, and alveolar dead-space fraction were estimated from positron emission tomography at baseline and 20 hours. RESULTS Alveolar dead-space fraction increased during the 20 hours (+0.05, P = .031), mainly in non-dependent regions (+0.03, P = .031). This was mediated by perfusion redistribution away from non-dependent regions (-5.9%, P = .031), while the spatial distribution of ventilation did not change, resulting in increased V ˙ / Q ˙ in non-dependent regions. The increased alveolar dead-space derived mostly from areas with intermediate V ˙ / Q ˙ (0.5≤ V ˙ / Q ˙ ≤10), not areas of nearly "complete" dead-space ( V ˙ / Q ˙ >10). CONCLUSIONS In this early ARDS model, increases in alveolar dead-space occur within 20 hours due to the regional redistribution of perfusion and not ventilation. This moderate redistribution suggests changes in the interplay between active and passive perfusion redistribution mechanisms (including hypoxic vasoconstriction and gravitational effects), not the appearance of thromboembolism. Hence, the association between mortality and increased dead-space possibly arises from the former, reflecting gas-exchange inefficiency due to perfusion heterogeneity. Such heterogeneity results from the injury and exhaustion of compensatory mechanisms for perfusion redistribution.
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Affiliation(s)
- Alessandro Beda
- Postgraduate Program of Electrical Engineering, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tilo Winkler
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tyler J. Wellman
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicolas De Prost
- Medical Intensive Care Unit, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Mauro Tucci
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Divisao de Pneumologia, Instituto do Coracao; Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcos F. Vidal Melo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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11
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Hinoshita T, Ribeiro GM, Winkler T, de Prost N, Tucci MR, Costa ELV, Wellman TJ, Hashimoto S, Zeng C, Carvalho AR, Melo MFV. Inflammatory Activity in Atelectatic and Normally Aerated Regions During Early Acute Lung Injury. Acad Radiol 2020; 27:1679-1690. [PMID: 32173290 DOI: 10.1016/j.acra.2019.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/07/2019] [Accepted: 12/14/2019] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES Pulmonary atelectasis presumably promotes and facilitates lung injury. However, data are limited on its direct and remote relation to inflammation. We aimed to assess regional 2-deoxy-2-[18F]-fluoro-D-glucose (18F-FDG) kinetics representative of inflammation in atelectatic and normally aerated regions in models of early lung injury. MATERIALS AND METHODS We studied supine sheep in four groups: Permissive Atelectasis (n = 6)-16 hours protective tidal volume (VT) and zero positive end-expiratory pressure; Mild (n = 5) and Moderate Endotoxemia (n = 6)- 20-24 hours protective ventilation and intravenous lipopolysaccharide (Mild = 2.5 and Moderate = 10.0 ng/kg/min), and Surfactant Depletion (n = 6)-saline lung lavage and 4 hours high VT. Measurements performed immediately after anesthesia induction served as controls (n = 8). Atelectasis was defined as regions of gas fraction <0.1 in transmission or computed tomography scans. 18F-FDG kinetics measured with positron emission tomography were analyzed with a three-compartment model. RESULTS 18F-FDG net uptake rate in atelectatic tissue was larger during Moderate Endotoxemia (0.0092 ± 0.0019/min) than controls (0.0051 ± 0.0014/min, p = 0.01). 18F-FDG phosphorylation rate in atelectatic tissue was larger in both endotoxemia groups (0.0287 ± 0.0075/min) than controls (0.0198 ± 0.0039/min, p = 0.05) while the 18F-FDG volume of distribution was not significantly different among groups. Additionally, normally aerated regions showed larger 18F-FDG uptake during Permissive Atelectasis (0.0031 ± 0.0005/min, p < 0.01), Mild (0.0028 ± 0.0006/min, p = 0.04), and Moderate Endotoxemia (0.0039 ± 0.0005/min, p < 0.01) than controls (0.0020 ± 0.0003/min). CONCLUSION Atelectatic regions present increased metabolic activation during moderate endotoxemia mostly due to increased 18F-FDG phosphorylation, indicative of increased cellular metabolic activation. Increased 18F-FDG uptake in normally aerated regions during permissive atelectasis suggests an injurious remote effect of atelectasis even with protective tidal volumes.
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Affiliation(s)
- Takuga Hinoshita
- Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit St. Boston, MA; Tokyo Medical and Dental University, Department of Intensive Care Medicine, Tokyo, Japan.
| | | | - Tilo Winkler
- Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit St. Boston, MA
| | - Nicolas de Prost
- Hôpital Henri Mondor, Medical Intensive Care Unit, Créteil, France
| | - Mauro R Tucci
- Hospital das Clínicas, Faculdade de Medicina, São Paulo, Brasil
| | | | | | - Soshi Hashimoto
- Kyoto Okamoto Memorial Hospital, Department of Anesthesiology, Kyoto, Japan
| | - Congli Zeng
- Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit St. Boston, MA; The First Affiliated Hospital, Department of Anesthesiology and Intensive Care, Zhejiang Sheng, China
| | - Alysson R Carvalho
- Carlos Chagas Filho Institute of Biophysics, Laboratory of Respiration Physiology, Rio de Janeiro, Brazil
| | - Marcos Francisco Vidal Melo
- Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit St. Boston, MA
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Nieman GF, Al-Khalisy H, Kollisch-Singule M, Satalin J, Blair S, Trikha G, Andrews P, Madden M, Gatto LA, Habashi NM. A Physiologically Informed Strategy to Effectively Open, Stabilize, and Protect the Acutely Injured Lung. Front Physiol 2020; 11:227. [PMID: 32265734 PMCID: PMC7096584 DOI: 10.3389/fphys.2020.00227] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/27/2020] [Indexed: 12/16/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) causes a heterogeneous lung injury and remains a serious medical problem, with one of the only treatments being supportive care in the form of mechanical ventilation. It is very difficult, however, to mechanically ventilate the heterogeneously damaged lung without causing secondary ventilator-induced lung injury (VILI). The acutely injured lung becomes time and pressure dependent, meaning that it takes more time and pressure to open the lung, and it recollapses more quickly and at higher pressure. Current protective ventilation strategies, ARDSnet low tidal volume (LVt) and the open lung approach (OLA), have been unsuccessful at further reducing ARDS mortality. We postulate that this is because the LVt strategy is constrained to ventilating a lung with a heterogeneous mix of normal and focalized injured tissue, and the OLA, although designed to fully open and stabilize the lung, is often unsuccessful at doing so. In this review we analyzed the pathophysiology of ARDS that renders the lung susceptible to VILI. We also analyzed the alterations in alveolar and alveolar duct mechanics that occur in the acutely injured lung and discussed how these alterations are a key mechanism driving VILI. Our analysis suggests that the time component of each mechanical breath, at both inspiration and expiration, is critical to normalize alveolar mechanics and protect the lung from VILI. Animal studies and a meta-analysis have suggested that the time-controlled adaptive ventilation (TCAV) method, using the airway pressure release ventilation mode, eliminates the constraints of ventilating a lung with heterogeneous injury, since it is highly effective at opening and stabilizing the time- and pressure-dependent lung. In animal studies it has been shown that by “casting open” the acutely injured lung with TCAV we can (1) reestablish normal expiratory lung volume as assessed by direct observation of subpleural alveoli; (2) return normal parenchymal microanatomical structural support, known as alveolar interdependence and parenchymal tethering, as assessed by morphometric analysis of lung histology; (3) facilitate regeneration of normal surfactant function measured as increases in surfactant proteins A and B; and (4) significantly increase lung compliance, which reduces the pathologic impact of driving pressure and mechanical power at any given tidal volume.
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Affiliation(s)
- Gary F Nieman
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Hassan Al-Khalisy
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States.,Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | | | - Joshua Satalin
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Sarah Blair
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Girish Trikha
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States.,Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Penny Andrews
- Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Maria Madden
- Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Louis A Gatto
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States.,Department of Biological Sciences, SUNY Cortland, Cortland, NY, United States
| | - Nader M Habashi
- Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States
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Motta-Ribeiro GC, Hashimoto S, Winkler T, Baron RM, Grogg K, Paula LFSC, Santos A, Zeng C, Hibbert K, Harris RS, Bajwa E, Vidal Melo MF. Deterioration of Regional Lung Strain and Inflammation during Early Lung Injury. Am J Respir Crit Care Med 2019; 198:891-902. [PMID: 29787304 DOI: 10.1164/rccm.201710-2038oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE The contribution of aeration heterogeneity to lung injury during early mechanical ventilation of uninjured lungs is unknown. OBJECTIVES To test the hypotheses that a strategy consistent with clinical practice does not protect from worsening in lung strains during the first 24 hours of ventilation of initially normal lungs exposed to mild systemic endotoxemia in supine versus prone position, and that local neutrophilic inflammation is associated with local strain and blood volume at global strains below a proposed injurious threshold. METHODS Voxel-level aeration and tidal strain were assessed by computed tomography in sheep ventilated with low Vt and positive end-expiratory pressure while receiving intravenous endotoxin. Regional inflammation and blood volume were estimated from 2-deoxy-2-[(18)F]fluoro-d-glucose (18F-FDG) positron emission tomography. MEASUREMENTS AND MAIN RESULTS Spatial heterogeneity of aeration and strain increased only in supine lungs (P < 0.001), with higher strains and atelectasis than prone at 24 hours. Absolute strains were lower than those considered globally injurious. Strains redistributed to higher aeration areas as lung injury progressed in supine lungs. At 24 hours, tissue-normalized 18F-FDG uptake increased more in atelectatic and moderately high-aeration regions (>70%) than in normally aerated regions (P < 0.01), with differential mechanistically relevant regional gene expression. 18F-FDG phosphorylation rate was associated with strain and blood volume. Imaging findings were confirmed in ventilated patients with sepsis. CONCLUSIONS Mechanical ventilation consistent with clinical practice did not generate excessive regional strain in heterogeneously aerated supine lungs. However, it allowed worsening of spatial strain distribution in these lungs, associated with increased inflammation. Our results support the implementation of early aeration homogenization in normal lungs.
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Affiliation(s)
- Gabriel C Motta-Ribeiro
- 1 Department of Anesthesia, Critical Care and Pain Medicine.,2 Biomedical Engineering Program, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Soshi Hashimoto
- 1 Department of Anesthesia, Critical Care and Pain Medicine.,3 Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan; and
| | - Tilo Winkler
- 1 Department of Anesthesia, Critical Care and Pain Medicine
| | - Rebecca M Baron
- 4 Department of Medicine (Pulmonary and Critical Care), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Arnoldo Santos
- 1 Department of Anesthesia, Critical Care and Pain Medicine.,6 CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Congli Zeng
- 1 Department of Anesthesia, Critical Care and Pain Medicine
| | - Kathryn Hibbert
- 7 Department of Medicine (Pulmonary and Critical Care), Massachusetts General Hospital, and
| | - Robert S Harris
- 7 Department of Medicine (Pulmonary and Critical Care), Massachusetts General Hospital, and
| | - Ednan Bajwa
- 7 Department of Medicine (Pulmonary and Critical Care), Massachusetts General Hospital, and
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Cereda M, Xin Y, Rizi RR. Acute Respiratory Distress Syndrome: Can Data from the Sick Guide Care for the Healthy? Am J Respir Crit Care Med 2019; 198:830-832. [PMID: 29787308 DOI: 10.1164/rccm.201804-0627ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Maurizio Cereda
- 1 Department of Anesthesiology and Critical Care University of Pennsylvania Philadelphia, Pennsylvania and
| | - Yi Xin
- 2 Department of Radiology University of Pennsylvania Philadelphia, Pennsylvania
| | - Rahim R Rizi
- 2 Department of Radiology University of Pennsylvania Philadelphia, Pennsylvania
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A Window on the Lung: Molecular Imaging as a Tool to Dissect Pathophysiologic Mechanisms of Acute Lung Disease. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:1510507. [PMID: 31531003 PMCID: PMC6732639 DOI: 10.1155/2019/1510507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/08/2019] [Indexed: 11/21/2022]
Abstract
In recent years, imaging has given a fundamental contribution to our understanding of the pathophysiology of acute lung diseases. Several methods have been developed based on computed tomography (CT), positron emission tomography (PET), and magnetic resonance (MR) imaging that allow regional, in vivo measurement of variables such as lung strain, alveolar size, metabolic activity of inflammatory cells, ventilation, and perfusion. Because several of these methods are noninvasive, they can be successfully translated from animal models to patients. The aim of this paper is to review the advances in knowledge that have been accrued with these imaging modalities on the pathophysiology of acute respiratory distress syndrome (ARDS), ventilator-induced lung injury (VILI), asthma and chronic obstructive pulmonary disease (COPD).
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Motta-Ribeiro G, Winkler T, Hashimoto S, Vidal Melo MF. Spatial Heterogeneity of Lung Strain and Aeration and Regional Inflammation During Early Lung Injury Assessed with PET/CT. Acad Radiol 2019; 26:313-325. [PMID: 30057194 PMCID: PMC6612262 DOI: 10.1016/j.acra.2018.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/20/2018] [Accepted: 02/27/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Spatial heterogeneity of lung aeration and strain (change volume/resting volume) occurs at microscopic levels and contributes to lung injury. Yet, it is mostly assessed with histograms or large regions-of-interest. Spatial heterogeneity could also influence regional gene expression. We used positron emission tomography (PET)/computed tomography (CT) to assess the contribution of different length-scales to mechanical heterogeneity and to direct lung injury biological pathway identification. MATERIALS AND METHODS Sheep exposed to mild (n = 5, supine and n = 3, prone) and moderate (n = 6, supine) systemic endotoxemia were protectively ventilated. At baseline, 6 hours and 20 hours length-scale analysis was applied to aeration in CT (mild groups) and PET transmission (moderate group) scans; and voxel-level strain derived from image registration of end-inspiratory and end-expiratory CTs (mild). 2-deoxy-2-[(18)F]fluoro-d-glucose (18F-FDG)-PET kinetics parameters in ventral and dorsal regions were correlated with tissue microarray gene expression (moderate). RESULTS While aeration and strain heterogeneity were highest at 5-10 mm length-scales, larger length-scales contained a higher fraction of strain than aeration heterogeneity. Contributions of length-scales >5-10 mm to aeration and strain heterogeneity increased as lung injury progressed (p < 0.001) and were higher in supine than prone animals. Genes expressed with regional correlation to 18F-FDG-PET kinetics (|r| = 0.81 [0.78-0.85]) yielded pathways associated with immune system activation and fluid clearance. CONCLUSION Normal spatial heterogeneity of aeration and strain suggest larger anatomical and functional determinants of lung strain than aeration heterogeneity. Lung injury and supine position increase the contribution of larger length-scales. 18F-FDG-PET-based categorization of gene expression results in known and novel biological pathways relevant to lung injury.
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Affiliation(s)
- Gabriel Motta-Ribeiro
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114.
| | - Tilo Winkler
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114.
| | - Soshi Hashimoto
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114.
| | - Marcos F Vidal Melo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114.
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Xin Y, Cereda M, Hamedani H, Pourfathi M, Siddiqui S, Meeder N, Kadlecek S, Duncan I, Profka H, Rajaei J, Tustison NJ, Gee JC, Kavanagh BP, Rizi RR. Unstable Inflation Causing Injury. Insight from Prone Position and Paired Computed Tomography Scans. Am J Respir Crit Care Med 2018; 198:197-207. [PMID: 29420904 PMCID: PMC6058981 DOI: 10.1164/rccm.201708-1728oc] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 02/08/2018] [Indexed: 01/16/2023] Open
Abstract
RATIONALE It remains unclear how prone positioning improves survival in acute respiratory distress syndrome. Using serial computed tomography (CT), we previously reported that "unstable" inflation (i.e., partial aeration with large tidal density swings, indicating increased local strain) is associated with injury progression. OBJECTIVES We prospectively tested whether prone position contains the early propagation of experimental lung injury by stabilizing inflation. METHODS Injury was induced by tracheal hydrochloric acid in rats; after randomization to supine or prone position, injurious ventilation was commenced using high tidal volume and low positive end-expiratory pressure. Paired end-inspiratory (EI) and end-expiratory (EE) CT scans were acquired at baseline and hourly up to 3 hours. Each sequential pair (EI, EE) of CT images was superimposed in parametric response maps to analyze inflation. Unstable inflation was then measured in each voxel in both dependent and nondependent lung. In addition, five pigs were imaged (EI and EE) prone versus supine, before and (1 hour) after hydrochloric acid aspiration. MEASUREMENTS AND MAIN RESULTS In rats, prone position limited lung injury propagation and increased survival (11/12 vs. 7/12 supine; P = 0.01). EI-EE densities, respiratory mechanics, and blood gases deteriorated more in supine versus prone rats. At baseline, more voxels with unstable inflation occurred in dependent versus nondependent regions when supine (41 ± 6% vs. 18 ± 7%; P < 0.01) but not when prone. In supine pigs, unstable inflation predominated in dorsal regions and was attenuated by prone positioning. CONCLUSIONS Prone position limits the radiologic progression of early lung injury. Minimizing unstable inflation in this setting may alleviate the burden of acute respiratory distress syndrome.
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Affiliation(s)
- Yi Xin
- Department of Radiology and
| | - Maurizio Cereda
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Natalie Meeder
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | - Nicholas J. Tustison
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia; and
| | | | - Brian P. Kavanagh
- Department of Critical Care Medicine and
- Department of Anesthesia, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Looking closer at acute respiratory distress syndrome: the role of advanced imaging techniques. Curr Opin Crit Care 2018; 23:30-37. [PMID: 27906709 DOI: 10.1097/mcc.0000000000000380] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Advanced imaging techniques have provided invaluable insights in understanding of acute respiratory distress syndrome (ARDS) and the effect of therapeutic strategies, thanks to the possibility of gaining regional information and moving from simple 'anatomical' information to in-vivo functional imaging. RECENT FINDINGS Computed tomography (CT) led to the understanding of several ARDS mechanisms and interaction with mechanical ventilation. It is nowadays frequently part of routine diagnostic workup, often leading to treatment changes. Moreover, CT is a reference for novel techniques both in clinical and preclinical studies. Bedside transthoracic lung ultrasound allows semiquantitative regional analysis of lung aeration, identifies ARDS lung morphology and response to therapeutic maneuvers. Electrical impedance tomography is a radiation-free, functional, bedside, imaging modality which allows a real-time monitoring of regional ventilation. Finally, positron emission tomography (PET) is a functional imaging technique that allows to trace physiologic processes, by administration of a radioactive molecule. PET with FDG has been applied to patients with ARDS, thanks to its ability to track the inflammatory cells activity. SUMMARY Progresses in lung imaging are key to individualize therapy, diagnosis, and pathophysiological mechanism at play in any patient at any specified time, helping to move toward personalized medicine for ARDS.
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Radermacher P, Maggiore SM, Mercat A. FiftyYears ofResearch inARDS.Gas Exchange in Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2017; 196:964-984. [DOI: 10.1164/rccm.201610-2156so] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Peter Radermacher
- Institute of Anaesthesiological Pathophysiology and Process Engineering, University Medical School, Ulm, Germany
| | - Salvatore Maurizio Maggiore
- Section of Anesthesia, Analgesia, Perioperative, and Intensive Care, Department of Medical, Oral, and Biotechnological Sciences, School of Medicine and Health Sciences, “SS. Annunziata” Hospital, “Gabriele d’Annunzio” University of Chieti-Pescara, Chieti, Italy; and
| | - Alain Mercat
- Department of Medical Intensive Care and Hyperbaric Medicine, Angers University Hospital, Angers, France
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Comprendre le poumon agressé. Actes du séminaire de recherche translationnelle de la Société de Réanimation de Langue Française (6 décembre 2016). MEDECINE INTENSIVE REANIMATION 2017. [PMCID: PMC7149235 DOI: 10.1007/s13546-017-1279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Le séminaire de recherche translationnelle 2016 organisé par la Société de Réanimation de Langue Française s’est focalisé sur les mécanismes de réponse à l’agression et de réparation pulmonaire. Le poumon représente une interface essentielle entre l’hôte et son environnement et est à ce titre soumis à des agressions constantes et multiples. La réanimation s’est en grande partie construite autour de la prise en charge de la défaillance respiratoire. Au-delà du traitement étiologique et du support ventilatoire, se pose la problématique récurrente du développement de thérapeutiques adjuvantes à visée immunomodulatrice. Le développement de telles thérapeutiques innovantes est conditionné par les avancées dans la compréhension de la physiopathologie de l’agression pulmonaire aiguë, ainsi que par la validation au lit du patient d’outils d’évaluation permettant de quantifier l’effet des interventions thérapeutiques.
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