Functional Respiratory Imaging of the Airways in the Acute Respiratory Distress Syndrome

Tom Schepens, Lu Xiao, Cedric Van Holsbeke, Wim Vos, Jan De Backer, Paul M Parizel, Wilfried De Backer, Lu Qin, Jean-Jacques Rouby, Philippe G Jorens

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BACKGROUND: Alveolar flooding and airway obstruction are present in the acute respiratory distress syndrome. The impact of positive end-expiratory pressure on regional airway aeration has not been described.

AIM: To assess bronchial and lung recruitment and distension during an incremental positive end-expiratory pressure trial in patients with acute respiratory distress syndrome.

METHODS: Six patients underwent lung and airway imaging at four positive end-expiratory pressure levels in a cohort trial. Images were post-processed by means of Functional Respiratory Imaging. This technique offers 3-dimensional visualisation and quantification of patients' airway and lung geometry on a regional level.

RESULTS: With increasing positive end-expiratory pressure from 0 to 20 cmH2O (high), the median bronchial recruitment was 151% and the median bronchial distension 43%. Non-aerated lower lobes bronchi had more bronchial volume increase at high positive end-expiratory pressure than partially aerated upper lobes bronchi. Lung recruitment tended to be higher in patients with non-focal acute respiratory distress syndrome. In two patients, bronchial volume increase at high positive end-expiratory pressure largely exceeded bronchial volume increase observed in matched healthy control subjects at total lung capacity, suggesting severe bronchial over-distension.

CONCLUSIONS: In early acute respiratory distress syndrome, Functional Respiratory Imaging gives an innovative insight into the relationship between positive end-expiratory pressure-induced bronchial distension and recruitment, positive end-expiratory pressure-induced lung recruitment and hyperinflation and lung morphology.

Original languageEnglish
JournalAnaesthesia Critical Care & Pain Medicine
Publication statusE-pub ahead of print - 7 Feb 2020
Externally publishedYes

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Copyright © 2020 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.


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