Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
Intensive Care Med. 2013 Jan;39(1):66-73. doi: 10.1007/s00134-012-2707-9. Epub 2012 Sep 19.
The computation of lung recruitability in acute respiratory distress syndrome (ARDS) is advocated to set positive end-expiratory pressure (PEEP) for preventing lung collapse. The quantitative lung CT scan, obtained by manual image processing, is the reference method but it is time consuming. The aim of this study was to evaluate the accuracy of a visual anatomical analysis compared with a quantitative lung CT scan analysis in assessing lung recruitability.
Fifty sets of two complete lung CT scans of ALI/ARDS patients computing lung recruitment were analyzed. Lung recruitability computed at an airway pressure of 5 and 45 cm H(2)O was defined as the percentage decrease in the collapsed/consolidated lung parenchyma assessed by two expert radiologists using a visual anatomical analysis and as the decrease in not aerated lung regions using a quantitative analysis computed by dedicated software.
Lung recruitability was 11.3 % (interquartile range 7.39-16.41) and 15.5 % (interquartile range 8.18-21.43) with the visual anatomical and quantitative analysis, respectively. In the Bland-Altman analysis, the bias and agreement bands between the visual anatomical and quantitative analysis were -2.9 % (-11.8 to +5.9 %). The ROC curve showed that the optimal cutoff values for the visual anatomical analysis in predicting high versus low lung recruitability was 8.9 % (area under the ROC curve 0.9248, 95 % CI 0.8550-0.9946). Considering this cutoff, the sensitivity, specificity, and diagnostic accuracy were 0.96, 0.76, and 0.86, respectively.
Visual anatomical analysis can classify patients into those with high and low lung recruitability allowing more intensivists to get access to lung recruitability assessment.
计算急性呼吸窘迫综合征（ARDS）的肺可复张性，以设置正呼气末压（PEEP），防止肺塌陷。通过手动图像处理获得的定量肺部 CT 扫描是参考方法，但耗时。本研究旨在评估视觉解剖分析与定量肺部 CT 扫描分析在评估肺可复张性方面的准确性。
对 50 例急性肺损伤/ARDS 患者的两组完整肺部 CT 扫描进行分析。使用两位专家放射科医生进行视觉解剖分析，将气道压力为 5 和 45 cm H2O 时计算的肺可复张性定义为塌陷/实变肺实质的百分比下降，使用专用软件计算的未充气肺区的减少作为定量分析。
视觉解剖分析和定量分析的肺可复张性分别为 11.3%（四分位间距 7.39-16.41）和 15.5%（四分位间距 8.18-21.43）。在 Bland-Altman 分析中，视觉解剖分析与定量分析之间的偏差和一致性带为-2.9%（-11.8 至+5.9%）。ROC 曲线显示，视觉解剖分析预测高肺可复张性与低肺可复张性的最佳截断值为 8.9%（ROC 曲线下面积 0.9248，95%CI 0.8550-0.9946）。考虑到该截断值，灵敏度、特异性和诊断准确性分别为 0.96、0.76 和 0.86。
视觉解剖分析可以将患者分为高肺可复张性和低肺可复张性，使更多的重症监护医生能够获得肺可复张性评估。
