Abstract.
Objectives: To study whether PEEP-induced reopening of collapsed lung regions – defined as the decrease in nonaerated lung volume measured on a single or three computerized tomographic (CT) sections – is representative of the decrease in overall nonaerated lung volume. Design: Review of 39 CT scans obtained in consecutive patients with Acute Lung Injury. Settings: Fourteen-bed surgical intensive care unit of a University Hospital. Measurements and results: PEEP-induced decrease in nonaerated lung volume was measured in 39 patients with ALI on a single juxtadiaphragmatic CT section, on three CT sections – apical, hilar, and juxtadiaphragmatic – and on contiguous apex-to-diaphragm CT sections. The percentage of decrease in nonaerated lung volume following PEEP, was compared between one, three and all CT sections using a linear regression analysis and Bland and Altman's method. The decrease in nonaerated lung volume measured on a single and three CT sections was significantly correlated with the decrease in nonaerated lung volume measured on all CT sections: R=0.83, P<0.0001 for one CT section and R=0.92, P<0.0001 for three CT sections. However, measurements performed on a single CT section were poorly representative of the overall lung: bias –6%, limits of agreement ranging between –37% and +25%. Measurements performed on three CT sections overestimated by 11% the overall decrease in nonaerated lung volume: bias –11%, limits of agreement ranging between –29% and +7%. Conclusions: PEEP-induced reopening of collapsed lung regions measured on a single or three CT sections sensibly differs from the reopening of collapsed lung regions measured on the overall lung. The inhomogeneous distribution of PEEP-induced reopening of collapsed lung regions along the cephalocaudal axis probably explains these discrepancies.
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Final revision received: 18 June 2001
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Lu, Q., Malbouisson, L., Mourgeon, E. et al. Assessment of PEEP-induced reopening of collapsed lung regions in acute lung injury: are one or three CT sections representative of the entire lung?. Intensive Care Med 27, 1504–1510 (2001). https://doi.org/10.1007/s001340101049
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DOI: https://doi.org/10.1007/s001340101049