Interaction of dependent and non-dependent regions of the acutely injured lung during a stepwise recruitment manoeuvre.
The benefit of treating acute lung injury with recruitment manoeuvres is controversial. An impediment to settling this debate is the difficulty in visualizing how distinct lung regions respond to the manoeuvre. Here, regional lung mechanics were studied by electrical impedance tomography (EIT) during a stepwise recruitment manoeuvre in a porcine model with acute lung injury. The following interaction between dependent and non-dependent regions consistently occurred: atelectasis in the most dependent region was reversed only after the non-dependent region became overdistended. EIT estimates of overdistension and atelectasis were validated by histological examination of lung tissue, confirming that the dependent region was primarily atelectatic and the non-dependent region was primarily overdistended. The pulmonary pressure-volume equation, originally designed for modelling measurements at the airway opening, was adapted for EIT-based regional estimates of overdistension and atelectasis. The adaptation accurately modelled the regional EIT data from dependent and non-dependent regions (R(2) > 0.93, P < 0.0001) and predicted their interaction during recruitment. In conclusion, EIT imaging of regional lung mechanics reveals that overdistension in the non-dependent region precedes atelectasis reversal in the dependent region during a stepwise recruitment manoeuvre.
Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
Camille
C
Gómez-Laberge
Jordan S
JS
Rettig
Craig D
CD
Smallwood
Theonia K
TK
Boyd
John H
JH
Arnold
Gerhard K
GK
Wolf
D055371:Acute Lung Injury / Q000175:diagnosis / Q000503:physiopathology* / Q000534:rehabilitation*; D000465:Algorithms; D000818:Animals; D002307:Cardiography, Impedance / Q000379:methods; D008168:Lung / Q000503:physiopathology*; D011175:Positive-Pressure Respiration / Q000009:adverse effects* / Q000379:methods*; D001261:Pulmonary Atelectasis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D013552:Swine; D016896:Treatment Outcome