From the Beckman Laser Institute (Y.M., L.-D.C., V.D., M.B., Z.C.), University of California, Irvine, Irvine, California; United States Army Institute of Surgical Research (J.H.C., T.R.R., B.M.B., D.S.W., M.E., K.S., L.C.C., A.I.B.), JBSA, Ft. Sam Houston, Texas; The Geneva Foundation (T.R.R., B.M.B., D.S.W., M.E., K.S.), Tacoma, Washington; and Morsani College of Medicine (T.R.R., A.I.B.), University of South Florida, Tampa, Florida.
J Trauma Acute Care Surg. 2019 Jul;87(1S Suppl 1):S132-S137. doi: 10.1097/TA.0000000000002277.
Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury with a mortality rate of up to 40%. Early management of ARDS has been difficult due to the lack of sensitive imaging tools and robust analysis software. We previously designed an optical coherence tomography (OCT) system to evaluate mucosa thickness (MT) after smoke inhalation, but the analysis relied on manual segmentation. The aim of this study is to assess in vivo proximal airway volume (PAV) after inhalation injury using automated OCT segmentation and correlate the PAV to lung function for rapid indication of ARDS.
Anesthetized female Yorkshire pigs (n = 14) received smoke inhalation injury (SII) and 40% total body surface area thermal burns. Measurements of PaO2-to-FiO2 ratio (PFR), peak inspiratory pressure (PIP), dynamic compliance, airway resistance, and OCT bronchoscopy were performed at baseline, postinjury, 24 hours, 48 hours, 72 hours after injury. A tissue segmentation algorithm based on graph theory was used to reconstruct a three-dimensional (3D) model of lower respiratory tract and estimate PAV. Proximal airway volume was correlated with PFR, PIP, compliance, resistance, and MT measurement using a linear regression model.
Proximal airway volume decreased after the SII: the group mean of proximal airway volume at baseline, postinjury, 24 hours, 48 hours, 72 hours were 20.86 cm (±1.39 cm), 17.61 cm (±0.99 cm), 14.83 cm (±1.20 cm), 14.88 cm (±1.21 cm), and 13.11 cm (±1.59 cm), respectively. The decrease in the PAV was more prominent in the animals that developed ARDS after 24 hours after the injury. PAV was significantly correlated with PIP (r = 0.48, p < 0.001), compliance (r = 0.55, p < 0.001), resistance (r = 0.35, p < 0.01), MT (r = 0.60, p < 0.001), and PFR (r = 0.34, p < 0.01).
Optical coherence tomography is a useful tool to quantify changes in MT and PAV after SII and burns, which can be used as predictors of developing ARDS at an early stage.
Prognostic, level III.
急性呼吸窘迫综合征（ARDS）是一种严重的急性肺损伤，死亡率高达 40%。由于缺乏敏感的影像学工具和强大的分析软件，ARDS 的早期管理一直存在困难。我们之前设计了一种光学相干断层扫描（OCT）系统来评估烟雾吸入后的黏膜厚度（MT），但分析依赖于手动分割。本研究旨在使用自动 OCT 分割评估吸入性损伤后的近端气道容积（PAV），并将 PAV 与肺功能相关联，以快速提示 ARDS。
麻醉雌性约克夏猪（n = 14）接受烟雾吸入性损伤（SII）和 40%全身表面积热烧伤。在基线、损伤后、24 小时、48 小时和 72 小时测量 PaO2 与 FiO2 比值（PFR）、吸气峰压（PIP）、动态顺应性、气道阻力和 OCT 支气管镜检查。使用基于图论的组织分割算法重建下呼吸道的三维（3D）模型并估计 PAV。使用线性回归模型将近端气道容积与 PFR、PIP、顺应性、阻力和 MT 测量值相关联。
SII 后近端气道容积减小：组内平均近端气道容积在基线、损伤后、24 小时、48 小时和 72 小时分别为 20.86 cm（±1.39 cm）、17.61 cm（±0.99 cm）、14.83 cm（±1.20 cm）、14.88 cm（±1.21 cm）和 13.11 cm（±1.59 cm）。损伤后 24 小时后发展为 ARDS 的动物 PAV 下降更为明显。PAV 与 PIP（r = 0.48，p < 0.001）、顺应性（r = 0.55，p < 0.001）、阻力（r = 0.35，p < 0.01）、MT（r = 0.60，p < 0.001）和 PFR（r = 0.34，p < 0.01）显著相关。
光学相干断层扫描是一种有用的工具，可定量测量 SII 和烧伤后 MT 和 PAV 的变化，可作为早期预测 ARDS 发生的指标。
预后，III 级。
