NDLI: Regional Tidal Lung Strain in Mechanically Ventilated Normal Lungs.

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Regional Tidal Lung Strain in Mechanically Ventilated Normal Lungs.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Paula, Luis Felipe Santos da Cruz Wellman, Tyler J. Winkler, Tilo Spieth, Peter Markus Güldner, Andreas Venegas, Jose Gabriel Gama de Abreu, Marcelo Carvalho, Alysson Roncally Vidal Melo, Marcos F.
Description	Author Affiliation: Paula LF ( Federal University of Rio de Janeiro.); Wellman TJ ( Boston University.); Winkler T ( Massachusetts General Hospital and Harvard Medical School.); Spieth PM ( Technische Universität Dresden.); Güldner A ( University Hospital Carl Gustav Carus, Dresden, Germany.); Venegas JG ( Massachusetts General Hospital/Harvard Medical School.); Gama de Abreu M ( University Hospital Dresden.); Carvalho AR ( Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.); Vidal Melo MF ( Massachusetts General Hospital and Harvard Medical School mvidalmelo@partners.org.)
Abstract	Parenchymal strain is a key determinant of lung injury produced by mechanical ventilation. However, imaging estimates of volumetric tidal strain (Æ=regional tidal volume/reference volume) present substantial conceptual differences in reference volume computation and consideration of tidally recruited lung. We compared current and new methods to estimate tidal volumetric strains with computed tomography, and quantified the effect of tidal volume (V ) and positive end-expiratory pressure (PEEP) on strain estimates. Eight supine pigs were ventilated with V =6 and 12 mL/kg and PEEP=0, 6, and 12 cmH O. End-expiratory and end-inspiratory scans were analyzed in eight regions-of-interest along the ventral-dorsal axis. Regional reference volumes were computed at end-expiration (with/without correction of regional V for intra-tidal recruitment) and at resting lung volume (PEEP=0) corrected for intra-tidal and PEEP-derived recruitment. All strain estimates demonstrated vertical heterogeneity with largest tidal strains in mid-dependent regions (p<0.01). Maximal strains for distinct estimates occurred at different lung regions and were differently affected by V -PEEP conditions. Values consistent with lung injury and inflammation were reached regionally, even when global measurements were below critical levels. Strains increased with V and were larger in mid-dependent than in nondependent lung regions. PEEP reduced tidal-strain estimates referenced to end-expiratory lung volumes, while it did not affect strains referenced to resting lung volume. These estimates of tidal strains in normal lungs point to mid-dependent lung regions as those at risk for ventilator-induced lung injury. The different conditions and topography at which maximal strain estimates occur allow for testing the importance of each estimate for lung injury.
File Format	HTM / HTML
ISSN	87507587
e-ISSN	15221601
Journal	Journal of Applied Physiology
Language	English
Publisher	American Physiological Society
Publisher Date	2016-07-21
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Applied Physiology Molecular Biology Biochemistry
Content Type	Text
Resource Type	Article
Subject	Physiology Physiology (medical) Sports Science

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