Assessment of the Effect of Recruitment Maneuver on Lung Aeration Through Imaging Analysis in Invasively Ventilated Patients: A Systematic Review

Frontiers in Physiology

Markus W. Hollmann¹  Frederique Paulus²  Marry R. Smit²  Laura A. Hagens²  Charalampos Pierrakos³  Nanon F. L. Heijnen⁴  Lieuwe D. J. Bos⁵  Marcus J. Schultz⁸ 

[1] Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands;Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands;Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium;Department of Intensive Care, Maastricht UMC+, Maastricht, Netherlands;Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands;Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands;Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand;Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom;

关键词: electrical impedance tomography;    computed tomography;    lung ultrasound;    overdistention;    recruitment maneuvers;    ARDS;   

DOI  :  10.3389/fphys.2021.666941

来源: DOAJ

【 摘 要 】

Background: Recruitment maneuvers (RMs) have heterogeneous effects on lung aeration and have adverse side effects. We aimed to identify morphological, anatomical, and functional imaging characteristics that might be used to predict the RMs on lung aeration in invasively ventilated patients.Methods: We performed a systemic review. Studies included invasively ventilated patients who received an RM and in whom re-aeration was examined with chest computed tomography (CT), electrical impedance tomography (EIT), and lung ultrasound (LUS) were included.Results: Twenty studies were identified. Different types of RMs were applied. The amount of re-aerated lung tissue after an RM was highly variable between patients in all studies, irrespective of the used imaging technique and the type of patients (ARDS or non-ARDS). Imaging findings suggesting a non-focal morphology (i.e., radiologic findings consistent with attenuations with diffuse or patchy loss of aeration) were associated with higher likelihood of recruitment and lower chance of overdistention than a focal morphology (i.e., radiological findings suggestive of lobar or segmental loss of aeration). This was independent of the used imaging technique but only observed in patients with ARDS. In patients without ARDS, the results were inconclusive.Conclusions: ARDS patients with imaging findings suggestive of non-focal morphology show most re-aeration of previously consolidated lung tissue after RMs. The role of imaging techniques in predicting the effect of RMs on re-aeration in patients without ARDS remains uncertain.

【 授权许可】

Unknown