Anatomical and functional intrapulmonary shunt in acute respiratory distress syndrome

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dc.contributor.authorCressoni, Massimo
dc.contributor.authorCaironi, Pietro
dc.contributor.authorPolli, Federico
dc.contributor.authorCarlesso, Eleonora
dc.contributor.authorChiumello, Davide
dc.contributor.authorCadringher, Paolo
dc.contributor.authorQuintel, Micheal
dc.contributor.authorRanieri, Vito Marco
dc.contributor.authorBugedo, Guillermo
dc.contributor.authorGattinoni, Luciano
dc.date.accessioned2024-01-10T13:11:04Z
dc.date.available2024-01-10T13:11:04Z
dc.date.issued2008
dc.description.abstractObjectives. The lung-protective strategy employs positive end expiratory pressure to keep open otherwise collapsed lung regions (anatomical recruitment). Improvement in venous admixture with positive end-expiratory pressure indicates functional recruitment to better gas exchange, which is not necessarily related to anatomical recruitment, because of possible global/regional perfusion modifications. Therefore, we aimed to assess the value of venous admixture (functional shunt) in estimating the fraction of nonaerated lung tissue (anatomical shunt compartment) and to describe their relationship.
dc.description.abstractDesign: Retrospective analysis of a previously published study.
dc.description.abstractSetting: Intensive care units of four university hospitals.
dc.description.abstractPatients. Fifty-nine patients with acute lung injury/acute respiratory distress syndrome.
dc.description.abstractInterventions., Positive end-expiratory pressure trial at 5 and 15 cm H2O positive end-expiratory pressures.
dc.description.abstractMeasurements and Main Results: Anatomical shunt compartment (whole-lung computed tomography scan) and functional shunt (blood gas analysis) were assessed at 5 and 15 cm H2O positive end-expiratory pressures. Apparent perfusion ratio (perfusion per gram of nonaerated tissue/perfusion per gram of total lung tissue) was defined as the ratio of functional shunt to anatomical shunt compartment. Functional shunt was poorly correlated to the anatomical shunt compartment (r(2) =.174). The apparent perfusion ratio at 5 cm H2O positive end-expiratory pressure was widely distributed and averaged 1.25 +/- 0.80. The apparent perfusion ratios at 5 and 15 cm H2O positive end expiratory pressures were highly correlated, with a slope close to identity (y = 1.10 center dot x -0.03, r(2) =.759), suggesting unchanged blood flow distribution toward the nonaerated lung tissue, when increasing positive end-expiratory pressure.
dc.description.abstractConclusions. Functional shunt poorly estimates the anatomical shunt compartment, due to the large variability in apparent perfusion ratio. Changes in anatomical shunt compartment with increasing positive end-expiratory pressure, in each individual patient, may be estimated from changes in functional shunt, only if the anatomical functional shunt relationship at 5 cm H2O positive end-expiratory pressure is known.
dc.fechaingreso.objetodigital2024-05-02
dc.format.extent7 páginas
dc.fuente.origenWOS
dc.identifier.doi10.1097/01.CCM.0000300276.12074.E1
dc.identifier.eissn1530-0293
dc.identifier.issn0090-3493
dc.identifier.pubmedidMEDLINE:18091555
dc.identifier.urihttps://doi.org/10.1097/01.CCM.0000300276.12074.E1
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/77990
dc.identifier.wosidWOS:000253450500001
dc.information.autorucMedicina;Bugedo G;S/I;60490
dc.issue.numero3
dc.language.isoen
dc.nota.accesocontenido parcial
dc.pagina.final675
dc.pagina.inicio669
dc.publisherLIPPINCOTT WILLIAMS & WILKINS
dc.revistaCRITICAL CARE MEDICINE
dc.rightsacceso restringido
dc.subjectrespiratory distress syndrome
dc.subjectadult
dc.subjectpulmonary gas exchange
dc.subjectcomputed tomography
dc.subjectpositive-pressure respiration
dc.subjectregional blood flow
dc.subjectPULMONARY BLOOD-FLOW
dc.subjectEND-EXPIRATORY PRESSURE
dc.subjectCARDIAC-OUTPUT
dc.subjectLUNG
dc.subjectPERFUSION
dc.subjectVENTILATION
dc.subjectENDOTOXIN
dc.subjectPEEP
dc.subjectVASOCONSTRICTION
dc.subject5-LIPOXYGENASE
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleAnatomical and functional intrapulmonary shunt in acute respiratory distress syndrome
dc.typeartículo
dc.volumen36
sipa.codpersvinculados60490
sipa.indexWOS
sipa.indexScopus
sipa.trazabilidadCarga SIPA;09-01-2024
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