Computertomographische Kriterien für den zu erwartenden Effekt von inhaliertem Stickstoffmonoxid bei Patienten mit schwerem akutem Lungenversagen
| Autor: | M. Deja, Roland Felix, H. Einfeld, R Röttgen, S Weber-Carstens, K. J. Falke, U. Kaisers, H. Lohbrunner, R J Schroeder, T. Busch |
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| Rok vydání: | 2005 |
| Předmět: |
medicine.medical_specialty
ARDS Lung Inhalation business.industry Oxygenation Blood flow respiratory system Lung injury medicine.disease respiratory tract diseases Nitric oxide chemistry.chemical_compound medicine.anatomical_structure chemistry Anesthesia Internal medicine Cardiology medicine Radiology Nuclear Medicine and imaging business Pathological |
| Zdroj: | RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. 177:805-811 |
| ISSN: | 1438-9010 1438-9029 |
| Popis: | PURPOSE: Inhaled nitric oxide (iNO) is an effective therapy for severe hypoxemia in most patients with acute respiratory distress syndrome (ARDS). For unknown reason, a subset of ARDS patients does not respond favorably to iNO therapy. We hypothesized that radiological manifestation of lung injury may be related to iNO response. MATERIALS AND METHODS: We retrospectively analyzed data from n = 25 ARDS patients who received iNO, and underwent chest CT within 72 h prior to inhaled treatment. The morphology of coherently pathologic lung tissue was characterized by the length of the borderline between consolidated, infiltrated and atelectatic lung tissue and radiologically normal lung tissue. This quantity was expressed as relative fraction of the visceral pleural circumference and averaged over all CT slices. Furthermore we semiquantitatively determined the total volume of consolidated lung tissue as part of the whole lung. RESULTS: In n = 6 non-responders to iNO (DeltaPaO2 10 %), we found significantly less coherently consolidated lung tissue evidenced by an increased relative borderline when compared to iNO non-responders (0.09 +/- 0.02 vs. 0.1 +/- 0.01; P < 0.05). Moreover, there was a moderate and significant correlation between DeltaPaO2 induced by iNO and the relative borderline in all patients studied (R = 0.59; P < 0.05). Total fraction of consolidated lung tissue volume was not different between iNO non-responders and responders (60 +/- 3 % vs. 54 +/- 2 % n. s.). CONCLUSION: Our data demonstrate that the gross morphological distribution of pathological lung tissue influences iNO response in ARDS. Inhaled NO was most beneficial in injured lungs characterized by many small consolidated areas surrounded by normal lung tissue. The increased borderline between pathologic and normal lung tissue offers additional possibility for iNO to divert blood flow from shunt areas to ventilated lung regions, which consequently improves arterial oxygenation. |
| Databáze: | OpenAIRE |
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