title: Acute respiratory distress syndrome: we can't miss regional lung perfusion!
abstract: In adult respiratory distress syndrome (ARDS), life-threatening hypoxemia may occur, dictating the need for differentiated ventilator strategies. Pronounced consolidation and/or atelectasis have been well documented in ARDS, but the contribution of regional perfusion to oxygenation has been poorly addressed. Evidence has accumulated that, in ARDS, regional perfusion is extremely variable and may affect oxygenation, independently from the amount of atelectatic-consolidated lung regions. Thus, the response in oxygenation to different ventilatory settings, both during controlled and assisted mechanical ventilation, should be interpreted with caution. In fact, gas exchange may be not determined solely by changes in aeration, but also redistribution of perfusion. Furthermore, regional perfusion can play an important role in worsening of lung injury due to increased transmural pressures. In addition, distribution of perfusion in lungs might affect the delivery of drugs through the pulmonary circulation, including antibiotics. In recent years, several techniques have been developed to determine pulmonary blood flow with increasing level of spatial resolution, allowing a better understanding of normal physiology and various pathophysiological conditions, but most of them are restricted to experimental or clinical research. Lung ultrasound and novel algorithms for electrical impedance tomography represent new promising techniques that could enable physicians to assess the distribution of pulmonary blood flow at the bedside. In ARDS, we cannot afford missing regional lung perfusion! Please see related article: http://dx.doi.org/10.1186/s12871-015-0013-0.
authors: Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy.
authors: Paolo
authors: P
authors: Pelosi
authors: Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus; Technische Universität Dresden, Dresden, Germany.
authors: Marcelo Gama
authors: MG
authors: de Abreu
mesh_terms: D000818:Animals; D006851:Hydrochloric Acid / Q000633:toxicity*; D055370:Lung Injury / Q000503:physiopathology*; D008297:Male; D011652:Pulmonary Circulation / Q000502:physiology*; D053120:Respiratory Aspiration / Q000503:physiopathology*
chemical_list: D006851:Hydrochloric Acid
keywords: Acute respiratory distress syndrome; Gas exchange; Lung imaging; Pulmonary blood flow; Ventilator induced lung injury