Lung Imaging in ARDS

Chapter

Abstract

The definition of acute respiratory distress syndrome (ARDS) has been recently revised with the new Berlin definition [1]. According to this latest definition, the diagnosis is based on the onset of the hypoxemia and of bilateral radiological opacities within 1 week. Three mutually exclusive categories of ARDS based on the degree of hypoxemia were identified (mild, ≤300 mmHg PaO2/FiO2 > 200 mmHg; moderate, ≤200 mmHg PaO2/FiO2>100 mm Hg; severe, PaO2/FiO2 ≤100 mmHg with a positive end-expiratory pressure ≥5 cmH2O) associated with increased mortality and associated with median length of mechanical ventilation in survivors. The new definition updated the following concepts:
  • The specific time frame identifying the acute onset as “ARDS developing within 1 week of a known clinical insult or new/worsening respiratory symptoms”

  • The origin of edema judging ARDS, a respiratory failure not fully explained by cardiac failure or fluid overload

  • The chest radiological criterion specifying that it should include bilateral opacities not fully explained by effusion, lobar lung collapse on chest radiograph, or on CT scan if available

Keywords

Acute Respiratory Distress Syndrome Electrical Impedance Tomography Acute Respiratory Distress Syndrome Patient Recruitment Maneuver Lung Recruitment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin Definition. JAMA 307:2526–2533PubMedGoogle Scholar
  2. 2.
    Dushianthan A, Grocott MP, Postle AD, Cusack R (2011) Acute respiratory distress syndrome and acute lung injury. Postgrad Med J 87:612–622CrossRefPubMedGoogle Scholar
  3. 3.
    Aberle DR, Brown K (1990) Radiologic considerations in the adult respiratory distress syndrome. Clin Chest Med 11:737–754PubMedGoogle Scholar
  4. 4.
    Endo S, Shibata S, Sato N, Hashiba E, Tajimi K, Saito K, Kawamae K, Nakane M, Murakawa M (2010) A prospective cohort study of ALI/ARDS in the Tohoku district of Japan (second report). J Anesth 24:351–358CrossRefPubMedGoogle Scholar
  5. 5.
    Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ (2004) Comparative diagnostic performances of auscultation, chest X-ray, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 100:9–15CrossRefPubMedGoogle Scholar
  6. 6.
    Oba Y, Zara T (2010) Abandoning daily routine chest radiography in the intensive care unit: meta-analysis. Radiology 255(2):386–395CrossRefPubMedGoogle Scholar
  7. 7.
    Pesenti A, Tagliabue P, Patroniti N, Fumagalli R (2001) Computerised tomography scan imaging in acute respiratory distress syndrome. Intensive Care Med 27(4):631–639CrossRefPubMedGoogle Scholar
  8. 8.
    Gattinoni L, Caironi P, Pelosi P, Goodman LR (2001) What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 164:1701–1711CrossRefPubMedGoogle Scholar
  9. 9.
    Desai SR, Wells AU, Rubens MB, Evans TW, Hansell DM (1999) Acute respiratory distress syndrome: CT abnormalities at long-term follow-up. Radiology 210(1):29–35CrossRefPubMedGoogle Scholar
  10. 10.
    Zompatori M, Ciccarese F, Fasano L (2014) Overview of current lung imaging in acute respiratory distress syndrome. Eur Respir Rev 23(134):519–530CrossRefPubMedGoogle Scholar
  11. 11.
    Goodman LR, Fumagalli R, Tagliabue P, Tagliabue M, Ferrario M, Gattinoni L, Pesenti A (1999) Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical and functional correlations. Radiology 213(2):545–552CrossRefPubMedGoogle Scholar
  12. 12.
    Gattinoni L, Pesenti A, Bombino M, Baglioni S, Rivolta M, Rossi F, Rossi G, Fumagalli R, Marcolin R, Mascheroni D (1988) Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology 69(6):824–832CrossRefPubMedGoogle Scholar
  13. 13.
    Gattinoni L, Pesenti A (2005) The concept of “baby lung”. Intensive Care Med 31(6):776–784Google Scholar
  14. 14.
    Pelosi P, D’Andrea L, Vitale G, Pesenti A, Gattinoni L (1994) Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care Med 149:8–13Google Scholar
  15. 15.
    Constantin JM, Cayot-Constantin S, Roszyk L, Futier E, Sapin V, Dastugue B, Bazin JE, Rouby JJ (2007) Response to recruitment maneuver influences net alveolar fluid clearance in acute respiratory distress syndrome. Anesthesiology 106:944–951CrossRefPubMedGoogle Scholar
  16. 16.
    Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T (2012) International evidence-based recommendations for point-of- care lung ultrasound. Intensive Care Med 38:577–591CrossRefPubMedGoogle Scholar
  17. 17.
    Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le Guen M, Girard M, Lu Q, Rouby JJ (2010) Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator- associated pneumonia. Crit Care Med 38:84–92CrossRefPubMedGoogle Scholar
  18. 18.
    Vieira SR, Puybasset L, Richecoeur J, Lu Q, Cluzel P, Gusman PB, Coriat P, Rouby JJ (1998) A lung computed tomographic assessment of positive end-expiratory pressure- induced lung overdistension. Am J Respir Crit Care Med 158:1571–1577CrossRefPubMedGoogle Scholar
  19. 19.
    Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, Russo S, Patroniti N, Cornejo R, Bugedo G (2006) Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 354:1775–1786CrossRefPubMedGoogle Scholar
  20. 20.
    Copetti R, Soldati G, Copetti P (2008) Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound 6:16CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bellani G, Amigoni M, Pesenti A (2011) Positron emission tomography in ARDS: a new look at an old syndrome. Minerva Anestesiol 77:439–447PubMedGoogle Scholar
  22. 22.
    Musch G (2011) Positron emission tomography: a tool for better understanding of ventilator-induced and acute lung injury. Curr Opin Crit Care 17:7–12CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bellani G, Messa C, Guerra L, Spagnoli E, Foti G, Patroniti N, Fumagalli R, Musch G, Fazio F, Pesenti A (2009) Lungs of patients with acute respiratory distress syndrome show diffuse inflammation in normally aerated regions: a [18F]-fluoro-2-deoxy-D-glucose PET/CT study. Crit Care Med 37:2216–2222CrossRefPubMedGoogle Scholar
  24. 24.
    Rodrigues RS, Miller PR, Bozza FA, Marchiori E, Zimmerman GA, Hoffman JM, Morton KA (2008) FDG-PET in patients at risk for acute respiratory distress syndrome: a preliminary report. Intensive Care Med 34:2273–2278CrossRefPubMedGoogle Scholar
  25. 25.
    Bellani G, Guerra L, Musch G, Zanella A, Patroniti N, Mauri T, Messa C, Pesenti A (2011) Lung regional metabolic activity and gas volume changes induced by tidal ventilation in patients with acute lung injury. Am J Respir Crit Care Med 183:1193–1199CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Chen DL, Bedient TJ, Kozlowski J, Rosenbluth DB, Isakow W, Ferkol TW, Thomas B, Mintun MA, Schuster DP, Walter MJ (2009) [18F]fluorodeoxyglucose positron emission tomography for lung antiinflammatory response evaluation. Am J Respir Crit Care Med 180:533–539CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Chiumello D, Froio S, Bouhemad B, Camporota L, Coppola S (2013) Clinical review: lung imaging in acute respiratory distress syndrome patients – an update. Crit Care 17:243–255Google Scholar
  28. 28.
    Cereda M, Emami K, Kadlecek S, Xin Y, Mongkolwisetwara P, Profka H, Barulic A, Pickup S, Mansson S, Wollmer P, Ishii M, Deutschman CS, Rizi RR (2011) Quantitative imaging of alveolar recruitment with hyperpolarized gas MRI during mechanical ventilation. J Appl Physiol 110:499–511CrossRefPubMedGoogle Scholar
  29. 29.
    Gattinoni L, Pelosi P, Crotti S, Valenza F (1995) Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med 151:1807–1814CrossRefPubMedGoogle Scholar
  30. 30.
    Malbouisson LM, Muller JC, Constantin JM, Lu Q, Puybasset L, Rouby JJ (2001) Computed tomography assessment of positive end-expiratory pressure- induced alveolar recruitment in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 163:1444–1450CrossRefPubMedGoogle Scholar
  31. 31.
    Chiumello D, Marino A, Brioni M, Cigada I, Menga F, Colombo A, Crimella F, Algeri I, Cressoni M, Carlesso E, Gattinoni L (2015) Lung recruitment assessed by respiratory mechanics and by CT scan: what is the relationship? Am J Respir Crit Care Med 193(11):1254–1263. PMID: 26699672Google Scholar
  32. 32.
    Chiumello D, Marino A, Brioni M, Menga F, Cigada I, Lazzerini M, Andrisani MC, Biondetti P, Cesana B, Gattinoni L (2012) Visual anatomical lung CT scan assessment of lung recruitability. Intensive Care Med 39:66–73CrossRefPubMedGoogle Scholar
  33. 33.
    Stefanidis K, Dimopoulos S, Tripodaki ES, Vitzilaios K, Politis P, Piperopoulos P, Nanas S (2011) Lung sonography and recruitment in patients with early acute respiratory distress syndrome: a pilot study. Crit Care 15:R185CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Bouhemd B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ (2011) Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med 183:341–347CrossRefGoogle Scholar
  35. 35.
    Chiumello D, Froio S, Coppola S (2013) Update on lung imaging to select ventilatory management in ARDS patients. In: Practical issues in anesthesia and intensive care. Springer, MilanGoogle Scholar
  36. 36.
    Lowhagen K, Lindgren S, Odenstedt H, Stenqvist O, Lundin S (2011) A new non- radiological method to assess potential lung recruitability: a pilot study in ALI patients. Acta Anaesthesiol Scand 55:165–174CrossRefPubMedGoogle Scholar
  37. 37.
    Grychtol B, Wolf GK, Adler A, Arnold JH (2010) Towards lung EIT image segmentation: automatic classification of lung tissue state from analysis of EIT monitored recruitment manoeuvres. Physiol Meas 31:S31–S43CrossRefPubMedGoogle Scholar
  38. 38.
    Muders T, Luepschen H, Zinserling J, Greschus S, Fimmers R, Guenther U, Buchwald M, Grigutsch D, Leonhardt S, Putensen C, Wrigge H (2012) Tidal recruitment assessed by electrical impedance tomography and computed tomography in a porcine model of lung injury. Crit Care Med 40:903–911CrossRefPubMedGoogle Scholar
  39. 39.
    Wrigge H, Zinserling J, Muders T, Varelmann D, Gunther U, von der GC, Magnusson A, Hedenstierna G, Putensen C (2008) Electrical impedance tomography compared with thoracic computed tomography during a slow inflation maneuver in experimental models of lung injury. Crit Care Med 36:903–909Google Scholar
  40. 40.
    Terragni PP, Rosboch G, Tealdi A, Corno E, Menaldo E, Davini O, Gandini G, Herrmann P, Mascia L, Quintel M, Slutsky AS, Gattinoni L, Ranieri VM (2007) Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med 175:160–166CrossRefPubMedGoogle Scholar
  41. 41.
    Cressoni M, Cadringher P, Chiurazzi C, Amini M, Gallazzi E, Marino A, Brioni M, Carlesso E, Chiumello D, Quintel M, Bugedo G, Gattinoni L (2014) Lung inhomogeneity in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 189:149–158PubMedGoogle Scholar
  42. 42.
    Pelosi P, de Abreu MG (2015) Acute respiratory distress syndrome: we can’t miss regional lung perfusion! BMC Anesthesiol 15:35Google Scholar
  43. 43.
    Dakin J, Jones AT, Hansell DM, Hoffman EA, Evans TW (2011) Changes in lung composition and regional perfusion and tissue distribution in patients with ARDS. Respirology 16:1265–1272CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Borges JB, Suarez-Sipmann F, Bohm SH, Tusman G, Melo A, Maripuu E, Sandstrom M, Park M, Costa EL, Hedenstierna G, Amato M (2012) Regional lung perfusion estimated by electrical impedance tomography in a piglet model of lung collapse. J Appl Physiol 112:225–236CrossRefPubMedGoogle Scholar
  45. 45.
    Gattinoni L, Presenti A, Torresin A, Baglioni S, Rivolta M, Rossi F, Scarani F, Marcolin R, Cappelletti G (1986) Adult respiratory distress syndrome profiles by computed tomography. J Thorac Imaging 1:25–30CrossRefPubMedGoogle Scholar
  46. 46.
    Chiumello D, Langer T, Vecchi V, Luoni S, Colombo A, Brioni M, Froio S, Cigada I, Coppola S, Protti A, Lazzerini M, Gattinoni L (2014) Low-dose chest computed tomography for quantitative and visual anatomical analysis in patients with acute respiratory distress syndrome. Intensive Care Med 40:691–699CrossRefPubMedGoogle Scholar
  47. 47.
    Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Sir Craft AW, Paker L, Berrington de Gonzalez A (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505Google Scholar
  48. 48.
    Sodickson A, Baeyens PF, Andriole KP, Prevedello LM, Nawfel RD, Hanson R, Kjorasani R (2009) Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 251:175–184CrossRefPubMedGoogle Scholar
  49. 49.
    Rohner DJ, Bennett S, Samaratunga C, Jewell ES, Smith JP, Gaskill-Shipley M, Lisco SJ (2013) Cumulative total effective whole-body radiation dose in critically ill patients. Chest 144:1481–1486CrossRefPubMedGoogle Scholar
  50. 50.
    Cardis E, Vrijheid M, Blettner M (2007) The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: estimates of radiation-related cancer risks. Radiat Res 167:396–416CrossRefPubMedGoogle Scholar
  51. 51.
    Shah DJ, Sachs RK, Wilson DJ (2012) Radiation-induced cancer: a modern view. Br J Radiol 85:e1166–e1173CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Naidich DP, Marshall CH, Gribbin C, Arams RS, McCauley DI (1990) Low- dose CT of the lungs: preliminary observations. Radiology 175:729–731CrossRefPubMedGoogle Scholar
  53. 53.
    Rhodes CG, Wollmer P, Fazio F, Jones T (1981) Quantitative measurement of regional extravascular lung density using positron emission and transmission tomography. J Comput Assist Tomogr 5:783–791CrossRefPubMedGoogle Scholar
  54. 54.
    Chen DL, Schstes DP (2004) Positron emission tomography with [18F]fluorodeoxyglucose to evaluate neutrophil kinetics during acute lung injury. Am J Phys Lung Cell Mol Phys 286:L834–L840Google Scholar
  55. 55.
    Sandiford P, Province MA, Schuster DP (1995) Distribution of regional density and vasculare permeability in the adult respiratory distress syndrome. Am J Respir Crit Care Med 151:737–742CrossRefPubMedGoogle Scholar
  56. 56.
    Fanara B, Manzon C, Barbot O, Desmettre T, Capellier G (2010) Recommendations for the intra-hospital transport of critically ill patients. Crit Care 14:R87CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Beckmann U, Gillies DM, Berenholtz SM, Wu AW, Pronovost P (2004) Incidents relating to the intra-hospital transfer of critically ill patients. An analysis of the reports submitted to the Australian Incident Monitoring Study in Intensive Care. Intensive Care Med 30(8):1579–1585CrossRefPubMedGoogle Scholar
  58. 58.
    http://www.ics.ac.uk Intensive Care Society: “Transfer medicine” in “Guidelines for the provision of intensive care services 2015”
  59. 59.
    http://www.ics.ac.uk 2011 Intensive Care Society: “Guidelines for the transport of the critically ill adult”
  60. 60.
    Aliaga M, Forel JM, de Bourmont S, Jung B, Thomas G, Mahul M, Bisbal M, Nougaret S, Hraiech S, Roch A, Chamuoitre K, Jaber S, Gainnier M, Papzian L (2015) Diagnostic yield and safety of CT scan in ICU. Intensive Care Med 41:436–443CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Dipartimento di Anestesia, Rianimazione ed Emergenza UrgenzaFondazione IRCCS Ca’ Granda–Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Director of Anaesthesia and Intensive Care Services, ASST Santi Paolo e Carlo, Department of Scienze della SaluteUniversity of MilanMilanItaly

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