Acute respiratory distress syndrome: we can't miss regional lung perfusion!

BMC Anesthesiology
Paolo Pelosi, Marcelo Gama de Abreu

Abstract

In adult respiratory distress syndrome (ARDS), life-threatening hypoxemia may occur, dictating the need for differentiated ventilator strategies. Pronounced consolidation and/or atelectasis have been well documented in ARDS, but the contribution of regional perfusion to oxygenation has been poorly addressed. Evidence has accumulated that, in ARDS, regional perfusion is extremely variable and may affect oxygenation, independently from the amount of atelectatic-consolidated lung regions. Thus, the response in oxygenation to different ventilatory settings, both during controlled and assisted mechanical ventilation, should be interpreted with caution. In fact, gas exchange may be not determined solely by changes in aeration, but also redistribution of perfusion. Furthermore, regional perfusion can play an important role in worsening of lung injury due to increased transmural pressures. In addition, distribution of perfusion in lungs might affect the delivery of drugs through the pulmonary circulation, including antibiotics. In recent years, several techniques have been developed to determine pulmonary blood flow with increasing level of spatial resolution, allowing a better understanding of normal physiology and various pathophysio...Continue Reading

References

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Nov 20, 2013·Current Opinion in Critical Care·Francesco CorradiPaolo Pelosi
Dec 17, 2014·Anesthesiology·Belaïd BouhemadIsabelle Rouquette
Mar 26, 2015·BMC Anesthesiology·Torsten RichterThea Koch

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Citations

Dec 19, 2015·BioMed Research International·András Lovas, Tamás Szakmány
Jan 22, 2019·Anesthesiology·Maurizio CeredaRahim R Rizi
Apr 10, 2018·Clinical Hemorheology and Microcirculation·Johannes GramattéTorsten Richter
Jun 25, 2021·Physiological Measurement·Benjamin HentzeSteffen Leonhardt

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Methods Mentioned

BETA
imaging techniques

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