Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstrasse 20, D-04103 Leipzig, Germany.
Crit Care. 2011;15(1):R71. doi: 10.1186/cc10060. Epub 2011 Feb 25.
Quantitative computed tomography (qCT)-based assessment of total lung weight (Mlung) has the potential to differentiate atelectasis from consolidation and could thus provide valuable information for managing trauma patients fulfilling commonly used criteria for acute lung injury (ALI). We hypothesized that qCT would identify atelectasis as a frequent mimic of early posttraumatic ALI.
In this prospective observational study, Mlung was calculated by qCT in 78 mechanically ventilated trauma patients fulfilling the ALI criteria at admission. A reference interval for Mlung was derived from 74 trauma patients with morphologically and functionally normal lungs (reference). Results are given as medians with interquartile ranges.
The ratio of arterial partial pressure of oxygen to the fraction of inspired oxygen was 560 (506 to 616) mmHg in reference patients and 169 (95 to 240) mmHg in ALI patients. The median reference Mlung value was 885 (771 to 973) g, and the reference interval for Mlung was 584 to 1164 g, which matched that of previous reports. Despite the significantly greater median Mlung value (1088 (862 to 1,342) g) in the ALI group, 46 (59%) ALI patients had Mlung values within the reference interval and thus most likely had atelectasis. In only 17 patients (22%), Mlung was increased to the range previously reported for ALI patients and compatible with lung consolidation. Statistically significant differences between atelectasis and consolidation patients were found for age, Lung Injury Score, Glasgow Coma Scale score, total lung volume, mass of the nonaerated lung compartment, ventilator-free days and intensive care unit-free days.
Atelectasis is a frequent cause of early posttraumatic lung dysfunction. Differentiation between atelectasis and consolidation from other causes of lung damage by using qCT may help to identify patients who could benefit from management strategies such as damage control surgery and lung-protective mechanical ventilation that focus on the prevention of pulmonary complications.
基于定量计算机断层扫描（qCT）的全肺重量（Mlung）评估有可能区分肺不张与实变，因此可为满足急性肺损伤（ALI）常用标准的创伤患者的管理提供有价值的信息。我们假设 qCT 将识别出肺不张是早期创伤后 ALI 的常见模拟。
在这项前瞻性观察性研究中，通过 qCT 计算了 78 名满足入院时 ALI 标准的机械通气创伤患者的 Mlung。从形态和功能正常的肺部的 74 名创伤患者中得出 Mlung 的参考区间（参考）。结果以中位数和四分位间距表示。
参考患者的动脉血氧分压与吸入氧分数之比为 560（506 至 616）mmHg，ALI 患者为 169（95 至 240）mmHg。参考患者的中位参考 Mlung 值为 885（771 至 973）g，Mlung 的参考区间为 584 至 1164 g，与之前的报告相匹配。尽管 ALI 组的中位数 Mlung 值明显更高（1088（862 至 1342）g），但 46（59%）名 ALI 患者的 Mlung 值在参考区间内，因此很可能患有肺不张。在仅 17 名患者（22%）中，Mlung 增加到先前报道的 ALI 患者范围，与肺实变相符。在年龄、肺损伤评分、格拉斯哥昏迷评分、总肺容量、非充气肺区质量、无呼吸机天数和无 ICU 天数方面，肺不张患者与实变患者之间存在统计学显著差异。
肺不张是创伤后早期肺功能障碍的常见原因。通过 qCT 将肺不张与实变与其他肺部损伤原因区分开来，可能有助于确定哪些患者可能受益于侧重于预防肺部并发症的管理策略，如损伤控制手术和肺保护性机械通气。
