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Synchrotron Imaging Shows Effect of Ventilator Settings on Intrabreath Cyclic Changes in Pulmonary Blood Volume
Univ Helsinki, Dept Phys, Helsinki, Finland.;Helsinki Univ Hosp, Med Imaging Ctr, Helsinki, Finland..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
Amiens Univ Hosp, Dept Pediat Intens Care, Amiens, France..
Univ Hosp Geneva, Anesthesiol Investigat Unit, Geneva, Switzerland..
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2017 (English)In: American Journal of Respiratory Cell and Molecular Biology, ISSN 1044-1549, E-ISSN 1535-4989, Vol. 57, no 4, 459-467 p.Article in journal (Refereed) Published
Abstract [en]

Despite the importance of dynamic changes in the regional distributions of gas and blood during the breathing cycle for lung function in the mechanically ventilated patient, no quantitative data on such cyclic changes are currently available. We used a novel gated synchrotron computed tomography imaging to quantitatively image regional lung gas volume (Vg), tissue density, and blood volume (Vb) in six anesthetized, paralyzed, and mechanically ventilated rabbits with normal lungs. Images were repeatedly collected during ventilation and steady-state inhalation of 50% xenon, or iodine infusion. Data were acquired in a dependent and nondependent image level, at zero end-expiratory pressure (ZEEP) and 9 cm H2O (positive end-expiratory pressure), and a tidal volume (V-T) of 6ml/kg(V(T)1) or 9ml/kg(V(T)2) at an Inspiratory: Expiratory ratio of 0.5 or 1.7 by applying an end-inspiratory pause. A video showing dynamic decreases in Vb during inspiration is presented. Vb decreased with positive end-expiratory pressure (P = 0.006; P = 0.036 versus V(T)1-ZEEP and V(T)2-ZEEP, respectively), and showed larger oscillations at the dependent image level, whereas a 45% increase in VT did not have a significant effect. End-inspiratory Vb minima were reduced by an end-inspiratory pause (P = 0.042, P = 0.006 at nondependent and dependent levels, respectively). Normalized regional Vg:Vb ratio increased upon inspiration. Our data demonstrate, for the first time, within-tidal cyclic variations in regional pulmonary Vb. The quantitative matching of regional Vg and Vb improved upon inspiration under ZEEP. Further study is underway to determine whether these phenomena affect intratidal gas exchange.

Place, publisher, year, edition, pages
AMER THORACIC SOC , 2017. Vol. 57, no 4, 459-467 p.
Keyword [en]
mechanical ventilation, ventilation distribution, synchrotrons, perfusion imaging, X-ray computed tomography
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-337116DOI: 10.1165/rcmb.2017-0007OCISI: 000412383900015PubMedID: 28535074OAI: oai:DiVA.org:uu-337116DiVA: diva2:1168562
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2017-12-21Bibliographically approved

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