Spinelli Elena, Perez Joaquin, Chiavieri Valentina, Leali Marco, Mansour Nadia, Madotto Fabiana, Rosso Lorenzo, Panigada Mauro, Grasselli Giacomo, Vaira Valentina, Mauri Tommaso
Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Crit Care Med. 2025 Jan 1;53(1):e42-e53. doi: 10.1097/CCM.0000000000006458. Epub 2024 Oct 24.
Pulmonary ventilation/perfusion (V/Q) mismatch measured by electrical impedance tomography (EIT) is associated with the outcome of patients with the acute respiratory distress syndrome (ARDS), but the underlying pathophysiological mechanisms have not been fully elucidated. The present study aimed to verify the correlation between relevant pathophysiological markers of ARDS severity and V/Q mismatch.
Prospective observational study.
General ICU of a university-affiliated hospital.
Deeply sedated intubated adult patients with ARDS under controlled mechanical ventilation.
Measures of V/Q mismatch by EIT, respiratory mechanics, gas exchange, lung imaging, and plasma biomarkers.
Unmatched V/Q units were assessed by EIT as the fraction of ventilated nonperfused plus perfused nonventilated lung units. At the same time, plasma biomarkers with proven prognostic and mechanistic significance for ARDS (carbonic anhydrase 9 [CA9], hypoxia-inducible factor 1 [HIF1], receptor for advanced glycation endproducts [RAGE], angiopoietin 2 [ANG2], gas exchange, respiratory mechanics, and quantitative chest CT scans were measured. Twenty-five intubated ARDS patients were included with median unmatched V/Q units of 37.1% (29.2-49.2%). Unmatched V/Q units were correlated with plasma levels of CA9 (rho = 0.47; p = 0.01), HIF1 (rho = 0.40; p = 0.05), RAGE (rho = 0.46; p = 0.02), and ANG2 (rho = 0.42; p = 0.03). Additionally, unmatched V/Q units correlated with plateau pressure ( r = 0.38; p = 0.05) and with the number of quadrants involved on chest radiograph ( r = 0.73; p < 0.01). Regional unmatched V/Q units were correlated with the corresponding fraction of poorly aerated lung tissue ( r = 0.62; p = 0.01) and of lung tissue weight (rho: 0.51; p = 0.04) measured by CT scan.
In ARDS patients, unmatched V/Q units are correlated with pathophysiological markers of lung epithelial and endothelial dysfunction, increased lung stress, and lung edema. Unmatched V/Q units could represent a comprehensive marker of ARDS severity, reflecting the complex organ pathophysiology and reinforcing their prognostic significance.
通过电阻抗断层扫描（EIT）测量的肺通气/灌注（V/Q）不匹配与急性呼吸窘迫综合征（ARDS）患者的预后相关，但其潜在的病理生理机制尚未完全阐明。本研究旨在验证ARDS严重程度的相关病理生理标志物与V/Q不匹配之间的相关性。
前瞻性观察性研究。
一所大学附属医院的综合重症监护病房。
在控制性机械通气下深度镇静插管的成年ARDS患者。
通过EIT、呼吸力学、气体交换、肺部成像和血浆生物标志物测量V/Q不匹配。
EIT将不匹配的V/Q单位评估为通气但无灌注的肺单位与灌注但无通气的肺单位的比例。同时，测量了对ARDS具有已证实的预后和机制意义的血浆生物标志物（碳酸酐酶9 [CA9]、缺氧诱导因子1 [HIF1]、晚期糖基化终产物受体 [RAGE]、血管生成素2 [ANG2]）、气体交换、呼吸力学和胸部CT定量扫描。纳入了25例插管的ARDS患者，不匹配的V/Q单位中位数为37.1%（29.2 - 49.2%）。不匹配的V/Q单位与CA9的血浆水平（rho = 0.47；p = 0.01）、HIF1（rho = 0.40；p = 0.（此处原文疑似有误，按照翻译习惯修正为0.05））、RAGE（rho = 0.46；p = 0.02）和ANG2（rho = 0.42；p = 0.03）相关。此外，不匹配的V/Q单位与平台压（r = 0.38；p = 0.05）以及胸部X线片受累象限数（r = 0.73；p < 0.01）相关。区域不匹配的V/Q单位与CT扫描测量的通气不良肺组织的相应比例（r = 0.62；p = 0.01）和肺组织重量（rho: 0.51；p = 0.04）相关。
在ARDS患者中，不匹配的V/Q单位与肺上皮和内皮功能障碍、肺应激增加和肺水肿的病理生理标志物相关。不匹配的V/Q单位可能代表ARDS严重程度的综合标志物，反映复杂的器官病理生理学并强化其预后意义。
