Abstract
In adult respiratory distress syndrome (ARDS), life-threatening hypoxemia may occur, dictating the need for differentiated ventilator strategies. Pronounced consolidation and/or atelectasis have been well documented in ARDS, but the contribution of regional perfusion to oxygenation has been poorly addressed. Evidence has accumulated that, in ARDS, regional perfusion is extremely variable and may affect oxygenation, independently from the amount of atelectatic-consolidated lung regions. Thus, the response in oxygenation to different ventilatory settings, both during controlled and assisted mechanical ventilation, should be interpreted with caution. In fact, gas exchange may be not determined solely by changes in aeration, but also redistribution of perfusion. Furthermore, regional perfusion can play an important role in worsening of lung injury due to increased transmural pressures. In addition, distribution of perfusion in lungs might affect the delivery of drugs through the pulmonary circulation, including antibiotics. In recent years, several techniques have been developed to determine pulmonary blood flow with increasing level of spatial resolution, allowing a better understanding of normal physiology and various pathophysiological conditions, but most of them are restricted to experimental or clinical research. Lung ultrasound and novel algorithms for electrical impedance tomography represent new promising techniques that could enable physicians to assess the distribution of pulmonary blood flow at the bedside. In ARDS, we cannot afford missing regional lung perfusion!Please see related article: http://dx.doi.org/10.1186/s12871-015-0013-0.
Highlights
The acute respiratory distress syndrome (ARDS) is an acute life-threatening condition, triggered by different clinical disorders, and characterized by severe hypoxemia refractory to increased inspired oxygen fraction, and high mortality [1]
Different imaging techniques such as computed tomography [2], electrical impedance tomography [3] and lung ultrasonography [4] have been used to investigate the distribution of aeration and/or ventilation in ARDS
Main text Richter et al [5] investigated the distribution of regional pulmonary blood flow in a model of acute lung injury induced by hydrochloric acid in rats
Summary
The acute respiratory distress syndrome (ARDS) is an acute life-threatening condition, triggered by different clinical disorders, and characterized by severe hypoxemia refractory to increased inspired oxygen fraction, and high mortality [1]. Hypoxemia is closely related to the consolidation or collapse of lung regions, which increase the intrapulmonary shunt. Most strategies aimed at improving oxygenation in ARDS target at the improvement of aeration and ventilation. Different imaging techniques such as computed tomography [2], electrical impedance tomography [3] and lung ultrasonography [4] have been used to investigate the distribution of aeration and/or ventilation in ARDS.
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