title: Use of computed tomography scanning to guide lung recruitment and adjust positive-end expiratory pressure.
abstract: OBJECTIVE
  We discuss the possible role of computed tomography (CT) to guide protective mechanical ventilation in acute lung injury/acute respiratory distress syndrome (ALI/ARDS), especially tidal volume (VT) and positive-end expiratory pressure (PEEP) settings and recruitment manoeuvres.
  
  
  RESULTS
  CT should be used as early as possible after the onset of ALI/ARDS and then repeated after 1 week in the absence of clinical improvement. Advantages of CT include: the regional response to recruitment can be determined; it is objective; the morphofunctional correlations obtained are useful for a comprehensive patient evaluation. CT should be performed at different pressure levels to identify potential for recruitment. Initially, one single whole-lung CT scan is performed at end-expiration at PEEP 5-10 cmH2O to evaluate aeration and compute lung weight. Afterwards, two lung CT slices are performed to assess lung recruitability (at PEEP = 5-10 cmH2O; inspiratory plateau pressure of the respiratory system = 45 cmH2O).
  
  
  CONCLUSIONS
  In ALI/ARDS patients, CT reveals discrepancies between bedside chest radiograph and various clinical and physiological parameters, and it is essential to assess lung morphology and recruitability. Specific algorithms, including or not CT, should be used to better identify ALI/ARDS with potential of recruitment and setting of VT and PEEP.
authors.affiliation: Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Universita' degli Studi di Genova, Genoa, Italy. ppelosi@hotmail.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.forename: Patricia Rm
authors.initials: PR
authors.lastname: Rocco
authors.forename: Marcelo Gama
authors.initials: MG
authors.lastname: de Abreu
mesh_terms: D006801:Humans; D011175:Positive-Pressure Respiration; D012128:Respiratory Distress Syndrome / Q000628:therapy; D013990:Tidal Volume; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055397:Ventilator-Induced Lung Injury / Q000517:prevention & control