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Perchiazzi G, Larina A, Hansen T, Frithiof R, Hultström M, Lipcsey M, Pellegrini M. Chest dual-energy CT to assess the effects of steroids on lung function in severe COVID-19 patients. Crit Care 2022; 26:328. [PMID: 36284360 PMCID: PMC9595078 DOI: 10.1186/s13054-022-04200-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Steroids have been shown to reduce inflammation, hypoxic pulmonary vasoconstriction (HPV) and lung edema. Based on evidence from clinical trials, steroids are widely used in severe COVID-19. However, the effects of steroids on pulmonary gas volume and blood volume in this group of patients are unexplored. OBJECTIVE Profiting by dual-energy computed tomography (DECT), we investigated the relationship between the use of steroids in COVID-19 and distribution of blood volume as an index of impaired HPV. We also investigated whether the use of steroids influences lung weight, as index of lung edema, and how it affects gas distribution. METHODS Severe COVID-19 patients included in a single-center prospective observational study at the intensive care unit at Uppsala University Hospital who had undergone DECT were enrolled in the current study. Patients' cohort was divided into two groups depending on the administration of steroids. From each patient's DECT, 20 gas volume maps and the corresponding 20 blood volume maps, evenly distributed along the cranial-caudal axis, were analyzed. As a proxy for HPV, pulmonary blood volume distribution was analyzed in both the whole lung and the hypoinflated areas. Total lung weight, index of lung edema, was estimated. RESULTS Sixty patients were analyzed, whereof 43 received steroids. Patients not exposed to steroids showed a more extensive non-perfused area (19% vs 13%, p < 0.01) and less homogeneous pulmonary blood volume of hypoinflated areas (kurtosis: 1.91 vs 2.69, p < 0.01), suggesting a preserved HPV compared to patients treated with steroids. Moreover, patients exposed to steroids showed a significantly lower lung weight (953 gr vs 1140 gr, p = 0.01). A reduction in alveolar-arterial difference of oxygen followed the treatment with steroids (322 ± 106 mmHg at admission vs 267 ± 99 mmHg at DECT, p = 0.04). CONCLUSIONS The use of steroids might cause impaired HPV and might reduce lung edema in severe COVID-19. This is consistent with previous findings in other diseases. Moreover, a reduced lung weight, as index of decreased lung edema, and a more homogeneous distribution of gas within the lung were shown in patients treated with steroids. TRIAL REGISTRATION Clinical Trials ID: NCT04316884, Registered March 13, 2020.
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Affiliation(s)
- Gaetano Perchiazzi
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, Ing 40, 3 tr, 751 85 Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Aleksandra Larina
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Tomas Hansen
- grid.8993.b0000 0004 1936 9457Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Michael Hultström
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, Ing 40, 3 tr, 751 85 Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Mariangela Pellegrini
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, Ing 40, 3 tr, 751 85 Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
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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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He H, Chi Y, Long Y, Yuan S, Zhang R, Yang Y, Frerichs I, Möller K, Fu F, Zhao Z. Three broad classifications of acute respiratory failure etiologies based on regional ventilation and perfusion by electrical impedance tomography: a hypothesis-generating study. Ann Intensive Care 2021; 11:134. [PMID: 34453622 PMCID: PMC8401348 DOI: 10.1186/s13613-021-00921-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/19/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of this study was to validate whether regional ventilation and perfusion data measured by electrical impedance tomography (EIT) with saline bolus could discriminate three broad acute respiratory failure (ARF) etiologies. METHODS Perfusion image was generated from EIT-based impedance-time curves caused by 10 ml 10% NaCl injection during a respiratory hold. Ventilation image was captured before the breath holding period under regular mechanical ventilation. DeadSpace%, Shunt% and VQMatch% were calculated based on lung perfusion and ventilation images. Ventilation and perfusion maps were divided into four cross-quadrants (lower left and right, upper left and right). Regional distribution defects of each quadrant were scored as 0 (distribution% ≥ 15%), 1 (15% > distribution% ≥ 10%) and 2 (distribution% < 10%). Data percentile distributions in the control group and clinical simplicity were taken into consideration when defining the scores. Overall defect scores (DefectV, DefectQ and DefectV+Q) were the sum of four cross-quadrants of the corresponding images. RESULTS A total of 108 ICU patients were prospectively included: 93 with ARF and 15 without as a control. PaO2/FiO2 was significantly correlated with VQMatch% (r = 0.324, P = 0.001). Three broad etiologies of ARF were identified based on clinical judgment: pulmonary embolism-related disease (PED, n = 14); diffuse lung involvement disease (DLD, n = 21) and focal lung involvement disease (FLD, n = 58). The PED group had a significantly higher DeadSpace% [40(24)% vs. 14(15)%, PED group vs. the rest of the subjects; median(interquartile range); P < 0.0001] and DefectQ score than the other groups [1(1) vs. 0(1), PED vs. the rest; P < 0.0001]. The DLD group had a significantly lower DefectV+Q score than the PED and FLD groups [0(1) vs. 2.5(2) vs. 3(3), DLD vs. PED vs. FLD; P < 0.0001]. The FLD group had a significantly higher DefectV score than the other groups [2(2) vs. 0(1), FLD vs. the rest; P < 0.0001]. The area under the receiver operating characteristic (AUC) for using DeadSpace% to identify PED was 0.894 in all ARF patients. The AUC for using the DefectV+Q score to identify DLD was 0.893. The AUC for using the DefectV score to identify FLD was 0.832. CONCLUSIONS Our study showed that it was feasible to characterize three broad etiologies of ARF with EIT-based regional ventilation and perfusion. Further study is required to validate clinical applicability of this method. Trial registration clinicaltrials, NCT04081142. Registered 9 September 2019-retrospectively registered, https://clinicaltrials.gov/show/NCT04081142 .
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Affiliation(s)
- Huaiwu He
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Chi
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yun Long
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
| | - Siyi Yuan
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Zhang
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingying Yang
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Knut Möller
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Feng Fu
- Department of Biomedical Engineering, Fourth Military Medical University, 169 Changle Xi Rd, Xi'an, China
| | - Zhanqi Zhao
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany.
- Department of Biomedical Engineering, Fourth Military Medical University, 169 Changle Xi Rd, Xi'an, China.
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Yen S, Song Y, Preissner M, Bennett E, Wilson R, Pavez M, Dubsky S, Dargaville PA, Fouras A, Zosky GR. The proteomic response is linked to regional lung volumes in ventilator-induced lung injury. J Appl Physiol (1985) 2020; 129:837-845. [PMID: 32758039 DOI: 10.1152/japplphysiol.00097.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
It is unclear how acid-induced lung injury alters the regional lung volume response to mechanical ventilation (MV) and how this impacts protein expression. Using a mouse model, we investigated the separate and combined effects of acid aspiration and MV on regional lung volumes and how these were associated with the proteome. Adult BALB/c mice were divided into four groups: intratracheal saline, intratracheal acid, saline/MV, or acid/MV. Specific tidal volume (sVt) and specific end-expiratory volume (sEEV) were measured at baseline and after 2 h of ventilation using dynamic high-resolution four-dimensional computed tomography (4DCT) images. Lung tissue was dissected into 10 regions corresponding to the image segmentation for label-free quantitative proteomic analysis. Our data showed that acid aspiration significantly reduced sVt and caused further reductions in sVt and sEEV after 2 h of ventilation. Proteomic analysis revealed 42 dysregulated proteins in both Saline/MV and Acid/MV groups, and 37 differentially expressed proteins in the Acid/MV group. Mapping of the overlapping proteins showed significant enrichment of complement/coagulation cascades (CCC). Analysis of 37 unique proteins in the Acid/MV group identified six additional CCC proteins and seven downregulated proteins involved in the mitochondrial respiratory chain (MRC). Regional MRC protein levels were positively correlated with sEEV, while the CCC protein levels were negatively associated with sVt. Therefore, this study showed that tidal volume was associated with the expression of CCC proteins, while low end-expiratory lung volumes were associated with MRC protein expression, suggesting that tidal stretch and lung collapse activate different injury pathways.NEW & NOTEWORTHY This study provides novel insights into the regional response to mechanical ventilation in the setting of acid-induced lung injury and highlights the complex interaction between tidal stretch and low-end-expiratory lung volumes; both of which caused altered regulation of different injury pathways.
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Affiliation(s)
- Seiha Yen
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Yong Song
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Melissa Preissner
- Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Victoria, Australia
| | - Ellen Bennett
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Richard Wilson
- Central Science Laboratory, University of Tasmania, Hobart, Tasmania, Australia
| | - Macarena Pavez
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Stephen Dubsky
- Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Victoria, Australia
| | - Peter A Dargaville
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Graeme R Zosky
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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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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Aaron CP, Hoffman EA, Kawut SM, Austin JHM, Budoff M, Michos ED, Hinckley Stukovsky K, Sack C, Szpiro AA, Watson KD, Kaufman JD, Barr RG. Ambient air pollution and pulmonary vascular volume on computed tomography: the MESA Air Pollution and Lung cohort studies. Eur Respir J 2019; 53:13993003.02116-2018. [PMID: 31167881 DOI: 10.1183/13993003.02116-2018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/14/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Air pollution alters small pulmonary vessels in animal models. We hypothesised that long-term ambient air pollution exposure would be associated with differences in pulmonary vascular volumes in a population-based study. METHODS The Multi-Ethnic Study of Atherosclerosis recruited adults in six US cities. Personalised long-term exposures to ambient black carbon, nitrogen dioxide (NO2), oxides of nitrogen (NO x ), particulate matter with a 50% cut-off aerodynamic diameter of <2.5 μm (PM2.5) and ozone were estimated using spatiotemporal models. In 2010-2012, total pulmonary vascular volume was measured as the volume of detectable pulmonary arteries and veins, including vessel walls and luminal blood volume, on noncontrast chest computed tomography (TPVVCT). Peripheral TPVVCT was limited to the peripheral 2 cm to isolate smaller vessels. Linear regression adjusted for demographics, anthropometrics, smoking, second-hand smoke, renal function and scanner manufacturer. RESULTS The mean±sd age of the 3023 participants was 69.3±9.3 years; 46% were never-smokers. Mean exposures were 0.80 μg·m-3 black carbon, 14.6 ppb NO2 and 11.0 μg·m-3 ambient PM2.5. Mean±sd peripheral TPVVCT was 79.2±18.2 cm3 and TPVVCT was 129.3±35.1 cm3. Greater black carbon exposure was associated with a larger peripheral TPVVCT, including after adjustment for city (mean difference 0.41 (95% CI 0.03-0.79) cm3 per interquartile range; p=0.036). Associations for peripheral TPVVCT with NO2 were similar but nonsignificant after city adjustment, while those for PM2.5 were of similar magnitude but nonsignificant after full adjustment. There were no associations for NO x or ozone, or between any pollutant and TPVVCT. CONCLUSIONS Long-term black carbon exposure was associated with a larger peripheral TPVVCT, suggesting diesel exhaust may contribute to remodelling of small pulmonary vessels in the general population.
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Affiliation(s)
- Carrie P Aaron
- Dept of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Eric A Hoffman
- Dept of Radiology, University of Iowa, Iowa City, IA, USA
| | - Steven M Kawut
- Depts of Medicine and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John H M Austin
- Dept of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Matthew Budoff
- Dept of Medicine, University of California, Los Angeles, CA, USA
| | - Erin D Michos
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Coralynn Sack
- Dept of Medicine, University of Washington, Seattle, WA, USA
| | - Adam A Szpiro
- Dept of Biostatistics, University of Washington, Seattle, WA, USA
| | - Karol D Watson
- Dept of Medicine, University of California, Los Angeles, CA, USA
| | - Joel D Kaufman
- Dept of Medicine, University of Washington, Seattle, WA, USA.,Dept of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.,Dept of Epidemiology, University of Washington, Seattle, WA, USA
| | - R Graham Barr
- Dept of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Dept of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Gramatté J, Pietzsch J, Bergmann R, Richter T. Causative treatment of acid aspiration induced acute lung injury - Recent trends from animal experiments and critical perspective. Clin Hemorheol Microcirc 2018; 69:187-195. [PMID: 29630538 DOI: 10.3233/ch-189113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Aspiration of low-pH gastric fluid leads to an initial pneumonitis, which may become complicated by subsequent pneumonia or acute respiratory distress syndrome. Current treatment is at best supportive, but there is growing experimental evidence on the significant contribution of both neutrophils and platelets in the development of this inflammatory pulmonary reaction, a condition that can be attenuated by several medicinal products. This review aims to summarize novel findings in experimental models on pathomechanisms after an acid-aspiration event. Given the clinical relevance, specific emphasis is put on deduced potential experimental therapeutic approaches, which make use of the characteristic alteration of microcirculation in the injured lung.
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Affiliation(s)
- Johannes Gramatté
- Department of Anesthesia and Intensive Care, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Jens Pietzsch
- Department of Radiopharmaceutical and Chemical Biology, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Department of Chemistry and Food Chemistry, Technische Universität Dresden, Dresden, Germany
| | - Ralf Bergmann
- Department of Radiopharmaceutical and Chemical Biology, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Torsten Richter
- Department of Anesthesia and Intensive Care, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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Ball L, Vercesi V, Costantino F, Chandrapatham K, Pelosi P. Lung imaging: how to get better look inside the lung. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:294. [PMID: 28828369 DOI: 10.21037/atm.2017.07.20] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the last years, imaging has played a key role in the diagnosis and monitoring and critical illness, including acute respiratory distress syndrome (ARDS). Chest X-ray (CXR) and computed tomography (CT) are the conventional techniques most performed in the critically ill patients, the latter being the gold standard to assess lung aeration in ARDS patients. In addition, two bedside techniques are now gaining popularity alongside the conventional ones: lung ultrasound (LUS) and electrical impedance tomography (EIT). These techniques do not involve the use of ionizing radiations, are non-invasive and relatively easy to use, and are under extensive investigation as a complement, and for some application a substitution of conventional techniques. At last, positron emission tomography (PET) and magnetic resonance imaging (MRI) can provide functional information on the lung and respiratory function, and are increasingly used in research to improve the understanding of the pathophysiological mechanisms underlying ARDS. The purpose of this review is to give an up-to-date overview of the conventional and emerging imaging techniques available the diagnosis and management of patients with ARDS.
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Affiliation(s)
- Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Veronica Vercesi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Federico Costantino
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Karthikka Chandrapatham
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
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Pesenti A, Musch G, Lichtenstein D, Mojoli F, Amato MBP, Cinnella G, Gattinoni L, Quintel M. Imaging in acute respiratory distress syndrome. Intensive Care Med 2016; 42:686-698. [DOI: 10.1007/s00134-016-4328-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/11/2016] [Indexed: 11/30/2022]
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