Background: Uncertain prediction of outcome in acute respiratory distress syndrome (ARDS) impedes individual patient management and clinical trial design.Objectives: To develop a radiological metric of injurious inflation derived from matched inspiratory and expiratory CT scans, calibrate it in a model of experimental lung injury, and test it in patients with ARDS.Methods: 73 anaesthetised rats (acid aspiration model) were ventilated (protective or non-protective) for up to 4 hours to generate a spectrum of lung injury. CT was performed (inspiratory and expiratory) at baseline each hour, paired inspiratory and expiratory images were superimposed and voxels tracked in sequential scans. In nine patients with ARDS, paired inspiratory and expiratory CT scans from the first intensive care unit week were analysed.Results: In experimental studies, regions of lung with unstable inflation (ie, partial or reversible airspace filling reflecting local strain) were the areas in which subsequent progression of injury was greatest in terms of progressive infiltrates (R=0.77) and impaired compliance (R=0.67, p<0.01). In patients with ARDS, a threshold fraction of tissue with unstable inflation was apparent: >28% in all patients who died and ≤28% in all who survived, whereas segregation of survivors versus non-survivors was not possible based on oxygenation or lung mechanics.Conclusions: A single set of superimposed inspiratory-expiratory CT scans may predict progression of lung injury and outcome in ARDS; if these preliminary results are validated, this could facilitate clinical trial recruitment and individualised care

Cereda, M., Xin, Y., Hamedani, H., Bellani, G., Kadlecek, S., Clapp, J., et al. (2017). Tidal changes on CT and progression of ARDS. THORAX, 72(11), 981-989 [10.1136/thoraxjnl-2016-209833].

Tidal changes on CT and progression of ARDS

CEREDA, MAURIZIO
Primo
;
BELLANI, GIACOMO;GUERRA, LUCA;
2017

Abstract

Background: Uncertain prediction of outcome in acute respiratory distress syndrome (ARDS) impedes individual patient management and clinical trial design.Objectives: To develop a radiological metric of injurious inflation derived from matched inspiratory and expiratory CT scans, calibrate it in a model of experimental lung injury, and test it in patients with ARDS.Methods: 73 anaesthetised rats (acid aspiration model) were ventilated (protective or non-protective) for up to 4 hours to generate a spectrum of lung injury. CT was performed (inspiratory and expiratory) at baseline each hour, paired inspiratory and expiratory images were superimposed and voxels tracked in sequential scans. In nine patients with ARDS, paired inspiratory and expiratory CT scans from the first intensive care unit week were analysed.Results: In experimental studies, regions of lung with unstable inflation (ie, partial or reversible airspace filling reflecting local strain) were the areas in which subsequent progression of injury was greatest in terms of progressive infiltrates (R=0.77) and impaired compliance (R=0.67, p<0.01). In patients with ARDS, a threshold fraction of tissue with unstable inflation was apparent: >28% in all patients who died and ≤28% in all who survived, whereas segregation of survivors versus non-survivors was not possible based on oxygenation or lung mechanics.Conclusions: A single set of superimposed inspiratory-expiratory CT scans may predict progression of lung injury and outcome in ARDS; if these preliminary results are validated, this could facilitate clinical trial recruitment and individualised care
Articolo in rivista - Articolo scientifico
Scientifica
acute lung injury; artificial respiration; computed tomography; diagnostic imaging; ventilator-induced lung injury\
English
Cereda, M., Xin, Y., Hamedani, H., Bellani, G., Kadlecek, S., Clapp, J., et al. (2017). Tidal changes on CT and progression of ARDS. THORAX, 72(11), 981-989 [10.1136/thoraxjnl-2016-209833].
Cereda, M; Xin, Y; Hamedani, H; Bellani, G; Kadlecek, S; Clapp, J; Guerra, L; Meeder, N; Rajaei, J; Tustison, N; Gee, J; Kavanagh, B; Rizi, R
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10281/158395
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