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Accuracy of the pressure-volume curve method compared to quantitative lung CT scan to assess the recruitable lung in patients with acute respiratory failure

Introduction

In patients with acute lung injury the knowledge of recruitable lung is useful for a physiological PEEP setting. The quantitative lung CT scan analysis remains the reference method [1]. However, it is time consuming and often it is not applicable in clinical management. The PV curve at two PEEP levels has been proposed as an alternative method [2]. The aim of this study was to evaluate the accuracy of these two methods in predicting the lung recruitability.

Methods

Sedated and paralyzed patients underwent a PV curve using the low-flow method and whole-lung CT scan at 5 and 15 cmH2O of PEEP. The lung recruitability was defined as the decrease in the not aerated tissue by the quantitative lung CT analysis and as the difference between the lung volume computed on the two PV curves for an airway pressure of 20 cmH2O.

Results

Ten patients (mean age 65.4 ± 10.4 years, body mass index 24.0 ± 6.8 kg/m2, PaO2/FiO2 181 ± 37) were enrolled. The mean recruitable lung was 3.9 ± 6.3% of the total lung weight and 218 ± 266 ml for the quantitative lung CT scan and PV curve. The linear regression between the two methods (Figure 1) was not significant (P = 0.338 and R2 = 0.115).

Figure 1
figure1

Linear regression between quantitative CT scan analysis and PV curve method.

Conclusion

The recruitable lung computed as the difference in not aerated tissue was not related to the difference in volume estimated by the PV curve. The role of the PV curve to estimate the lung recruitability remains to be elucidated.

References

  1. 1.

    Gattinoni L, et al.: Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 2006, 354: 1775-1786. 10.1056/NEJMoa052052

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  2. 2.

    Ranieri VM, et al.: Volume-pressure curve of the respiratory system predicts effects of PEEP in ARDS: 'occlusion' versus 'constant flow' technique. Am J Respir Crit Care Med 1994, 149: 19-27.

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Correspondence to D Chiumello.

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Chiumello, D., Marino, A., Cigada, I. et al. Accuracy of the pressure-volume curve method compared to quantitative lung CT scan to assess the recruitable lung in patients with acute respiratory failure. Crit Care 16, P104 (2012). https://doi.org/10.1186/cc10711

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Keywords

  • Body Mass Index
  • Lung Injury
  • Respiratory Failure
  • Clinical Management
  • Acute Lung Injury