Lung regional metabolic activity and gas volume changes induced by tidal ventilation in patients with acute lung injury

Giacomo Bellani, Luca Guerra, Guido Musch, Alberto Zanella, Nicolò Patroniti, Tommaso Mauri, Cristina Messa, Antonio Pesenti

Research output: Contribution to journalArticle

128 Scopus citations

Abstract

Rationale: During acute lung injury (ALI), mechanical ventilation can aggravate inflammation by promoting alveolar distension and cyclic recruitment-derecruitment. As an estimate of the intensity of inflammation,metabolic activity can bemeasured by positrone-mission tomography imaging of [18F]fluoro-2-deoxy-D-glucose. Objectives: To assess the relationship between gas volume changes induced by tidal ventilation and pulmonary metabolic activity in patients with ALI. Methods: In 13 mechanically ventilated patients with ALI and relatively high positive end-expiratory pressure, we performed a positron emission tomography scan of the chest and three computed tomography scans: at mean airway pressure, end-expiration, and end-inspiration. Metabolicactivitywasmeasuredfromthe[18F]fluoro-2-deoxy-D-glucose uptake rate. The computed tomography scans were used to classify lung regions as derecruited throughout the respiratory cycle, undergoing recruitment-derecruitment, and normally aerated. Measurements and Main Results: Metabolic activity of normally aerated lung was positively correlated both with plateau pressure, showing a pronounced increase above 26 to 27 cm H2O, and with regional VT normalized by end-expiratory lung gas volume. This relationship did not appear to be caused by a higher underlying parenchymal metabolic activity in patients with higher plateau pressure. Regions undergoing cyclic recruitment-derecruitment did not have higher metabolic activity than those collapsed throughout the respiratory cycle. Conclusions: In patients with ALI managed with relatively high end-expiratory pressure, metabolic activity of aerated regions was associated with both plateau pressure and regional VT normalized by end-expiratory lung gas volume, whereas no association was found between cyclic recruitment- derecruitment and increased metabolic activity.

Original languageEnglish
Pages (from-to)1193-1199
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Volume183
Issue number9
DOIs
StatePublished - May 1 2011

Keywords

  • Acute lung injury
  • Artificial
  • Positron emission tomography
  • Respiration
  • Tomography
  • X-ray computed

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