tetano
Editor, Senior Moderator
Sci Rep
. 2024 Jun 24;14(1):14477.
doi: 10.1038/s41598-024-64622-3. Correlation between normally aerated lung and respiratory system compliance at clinical high positive end-expiratory pressure in patients with COVID-19
Keishi Ogura[SUP] #[/SUP][SUP] 1 [/SUP], Ryuichi Nakayama[SUP] #[/SUP][SUP] 2 [/SUP], Naofumi Bunya[SUP] 3 [/SUP], Shinshu Katayama[SUP] 4 [/SUP], Naoya Yama[SUP] 5 [/SUP], Yuya Goto[SUP] 6 [/SUP], Keigo Sawamoto[SUP] 3 [/SUP], Shuji Uemura[SUP] 3 [/SUP], Eichi Narimatsu[SUP] 3 [/SUP]
Affiliations
Normally aerated lung tissue on computed tomography (CT) is correlated with static respiratory system compliance (C[SUB]rs[/SUB]) at zero end-expiratory pressure. In clinical practice, however, patients with acute respiratory failure are often managed using elevated PEEP levels. No study has validated the relationship between lung volume and tissue and C[SUB]rs[/SUB] at the applied positive end-expiratory pressure (PEEP). Therefore, this study aimed to demonstrate the relationship between lung volume and tissue on CT and C[SUB]rs[/SUB] during the application of PEEP for the clinical management of patients with acute respiratory distress syndrome due to COVID-19. Additionally, as a secondary outcome, the study aimed to evaluate the relationship between CT characteristics and C[SUB]rs[/SUB], considering recruitability using the recruitment-to-inflation ratio (R/I ratio). We analyzed the CT and respiratory mechanics data of 30 patients with COVID-19 who were mechanically ventilated. The CT images were acquired during mechanical ventilation at PEEP level of 15 cmH[SUB]2[/SUB]O and were quantitatively analyzed using Synapse Vincent system version 6.4 (Fujifilm Corporation, Tokyo, Japan). Recruitability was stratified into two groups, high and low recruitability, based on the median R/I ratio of our study population. Thirty patients were included in the analysis with the median R/I ratio of 0.71. A significant correlation was observed between C[SUB]rs[/SUB] at the applied PEEP (median 15 [interquartile range (IQR) 12.2, 15.8]) and the normally aerated lung volume (r = 0.70 [95% CI 0.46-0.85], P < 0.001) and tissue (r = 0.70 [95% CI 0.46-0.85], P < 0.001). Multivariable linear regression revealed that recruitability (Coefficient = - 390.9 [95% CI - 725.0 to - 56.8], P = 0.024) and C[SUB]rs[/SUB] (Coefficient = 48.9 [95% CI 32.6-65.2], P < 0.001) were significantly associated with normally aerated lung volume (R-squared: 0.58). In this study, C[SUB]rs[/SUB] at the applied PEEP was significantly correlated with normally aerated lung volume and tissue on CT. Moreover, recruitability indicated by the R/I ratio and C[SUB]rs[/SUB] were significantly associated with the normally aerated lung volume. This research underscores the significance of C[SUB]rs[/SUB] at the applied PEEP as a bedside-measurable parameter and sheds new light on the link between recruitability and normally aerated lung.
Keywords: Computed tomography; Coronavirus disease 2019; Mechanical ventilation; Recruitability; Respiratory distress syndrome; Respiratory system compliance.
. 2024 Jun 24;14(1):14477.
doi: 10.1038/s41598-024-64622-3. Correlation between normally aerated lung and respiratory system compliance at clinical high positive end-expiratory pressure in patients with COVID-19
Keishi Ogura[SUP] #[/SUP][SUP] 1 [/SUP], Ryuichi Nakayama[SUP] #[/SUP][SUP] 2 [/SUP], Naofumi Bunya[SUP] 3 [/SUP], Shinshu Katayama[SUP] 4 [/SUP], Naoya Yama[SUP] 5 [/SUP], Yuya Goto[SUP] 6 [/SUP], Keigo Sawamoto[SUP] 3 [/SUP], Shuji Uemura[SUP] 3 [/SUP], Eichi Narimatsu[SUP] 3 [/SUP]
Affiliations
- PMID: 38914620
- DOI: 10.1038/s41598-024-64622-3
Normally aerated lung tissue on computed tomography (CT) is correlated with static respiratory system compliance (C[SUB]rs[/SUB]) at zero end-expiratory pressure. In clinical practice, however, patients with acute respiratory failure are often managed using elevated PEEP levels. No study has validated the relationship between lung volume and tissue and C[SUB]rs[/SUB] at the applied positive end-expiratory pressure (PEEP). Therefore, this study aimed to demonstrate the relationship between lung volume and tissue on CT and C[SUB]rs[/SUB] during the application of PEEP for the clinical management of patients with acute respiratory distress syndrome due to COVID-19. Additionally, as a secondary outcome, the study aimed to evaluate the relationship between CT characteristics and C[SUB]rs[/SUB], considering recruitability using the recruitment-to-inflation ratio (R/I ratio). We analyzed the CT and respiratory mechanics data of 30 patients with COVID-19 who were mechanically ventilated. The CT images were acquired during mechanical ventilation at PEEP level of 15 cmH[SUB]2[/SUB]O and were quantitatively analyzed using Synapse Vincent system version 6.4 (Fujifilm Corporation, Tokyo, Japan). Recruitability was stratified into two groups, high and low recruitability, based on the median R/I ratio of our study population. Thirty patients were included in the analysis with the median R/I ratio of 0.71. A significant correlation was observed between C[SUB]rs[/SUB] at the applied PEEP (median 15 [interquartile range (IQR) 12.2, 15.8]) and the normally aerated lung volume (r = 0.70 [95% CI 0.46-0.85], P < 0.001) and tissue (r = 0.70 [95% CI 0.46-0.85], P < 0.001). Multivariable linear regression revealed that recruitability (Coefficient = - 390.9 [95% CI - 725.0 to - 56.8], P = 0.024) and C[SUB]rs[/SUB] (Coefficient = 48.9 [95% CI 32.6-65.2], P < 0.001) were significantly associated with normally aerated lung volume (R-squared: 0.58). In this study, C[SUB]rs[/SUB] at the applied PEEP was significantly correlated with normally aerated lung volume and tissue on CT. Moreover, recruitability indicated by the R/I ratio and C[SUB]rs[/SUB] were significantly associated with the normally aerated lung volume. This research underscores the significance of C[SUB]rs[/SUB] at the applied PEEP as a bedside-measurable parameter and sheds new light on the link between recruitability and normally aerated lung.
Keywords: Computed tomography; Coronavirus disease 2019; Mechanical ventilation; Recruitability; Respiratory distress syndrome; Respiratory system compliance.