title: Visual anatomical lung CT scan assessment of lung recruitability.
abstract: OBJECTIVE
  The computation of lung recruitability in acute respiratory distress syndrome (ARDS) is advocated to set positive end-expiratory pressure (PEEP) for preventing lung collapse. The quantitative lung CT scan, obtained by manual image processing, is the reference method but it is time consuming. The aim of this study was to evaluate the accuracy of a visual anatomical analysis compared with a quantitative lung CT scan analysis in assessing lung recruitability.
  
  
  METHODS
  Fifty sets of two complete lung CT scans of ALI/ARDS patients computing lung recruitment were analyzed. Lung recruitability computed at an airway pressure of 5 and 45 cm H(2)O was defined as the percentage decrease in the collapsed/consolidated lung parenchyma assessed by two expert radiologists using a visual anatomical analysis and as the decrease in not aerated lung regions using a quantitative analysis computed by dedicated software.
  
  
  RESULTS
  Lung recruitability was 11.3 % (interquartile range 7.39-16.41) and 15.5 % (interquartile range 8.18-21.43) with the visual anatomical and quantitative analysis, respectively. In the Bland-Altman analysis, the bias and agreement bands between the visual anatomical and quantitative analysis were -2.9 % (-11.8 to +5.9 %). The ROC curve showed that the optimal cutoff values for the visual anatomical analysis in predicting high versus low lung recruitability was 8.9 % (area under the ROC curve 0.9248, 95 % CI 0.8550-0.9946). Considering this cutoff, the sensitivity, specificity, and diagnostic accuracy were 0.96, 0.76, and 0.86, respectively.
  
  
  CONCLUSIONS
  Visual anatomical analysis can classify patients into those with high and low lung recruitability allowing more intensivists to get access to lung recruitability assessment.
authors.affiliation: Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. chiumello@libero.it
authors.forename: Davide
authors.initials: D
authors.lastname: Chiumello
authors.forename: Antonella
authors.initials: A
authors.lastname: Marino
authors.forename: Matteo
authors.initials: M
authors.lastname: Brioni
authors.forename: Federica
authors.initials: F
authors.lastname: Menga
authors.forename: Irene
authors.initials: I
authors.lastname: Cigada
authors.forename: Marco
authors.initials: M
authors.lastname: Lazzerini
authors.forename: Maria C
authors.initials: MC
authors.lastname: Andrisani
authors.forename: Pietro
authors.initials: P
authors.lastname: Biondetti
authors.forename: Bruno
authors.initials: B
authors.lastname: Cesana
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
mesh_terms: D055371:Acute Lung Injury / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed