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CT Scan May Predict Therapy Success in Acute Lung Injury

Higher PEEP may provide no benefit to patients with a low percentage of potentially recruitable lung

WEDNESDAY, April 26 (HealthDay News) -- The percentage of potentially recruitable lung in acute respiratory distress syndrome (ARDS) varies and is associated with the response to positive end-expiratory pressure (PEEP), according to a study in the April 27 issue of the New England Journal of Medicine.

Luciano Gattinoni, M.D., of the Universita degli Studi di Milano in Italy, and colleagues studied 68 patients with acute lung injury or ARDS who underwent whole-lung computed tomography during breath-holding sessions at airway pressures of 5, 15 and 45 cm of water. Potentially recruitable lung was defined as the proportion of lung tissue that could be restored to aeration at these pressures.

The percentage of potentially recruitable lung varied from 2 percent to 24 percent and was associated with the percentage of lung tissue in which aeration was maintained after PEEP application. They also found that an average of 24 percent of the lung could not be recruited. Patients with a higher percentage of potentially recruitable lung had poorer oxygenation, more dead space and higher mortality than patients with a lower percentage.

"Future studies investigating the optimal strategy for the setting of PEEP levels must take into account the degree to which the lungs can be recruited," states the author of an accompanying editorial. "In this postgenomic era, Gattinoni et al. demonstrate that sound physiological principles are still relevant to our understanding of disease processes. Such principles, along with advances in knowledge of cellular and molecular biology, should lead to improvements in the care of our critically ill patients."

Three researchers have received consulting fees, lecture fees and grant support from drug companies.

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