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Chest CT scan and alveolar procollagen III to predict lung fibroproliferation in acute respiratory distress syndrome.

ABSTRACT: BACKGROUND:Lung fibroproliferation in ARDS patients is associated with mortality. Alveolar procollagen III (NT-PCP-III) is a validated biomarker of lung fibroproliferation. A chest CT scan could be useful for the diagnosis of lung fibroproliferation. The aim of this study was to identify lung fibroproliferative CT scan aspects in ARDS patients with high levels of NT-PCP-III. RESULTS:This retrospective study included ARDS patients who had at least one assessment of alveolar NT-PCP-III and a chest CT scan within 3 days before or after NT-PCP-III determination. An alveolar level of NT-PCP-III?>?9 µG/L indicated fibroproliferation. The CT scan was scored on interstitial and alveolar abnormalities. Each lobe was scored from 0 to 5 according to the severity of the abnormalities. The crude score and the corrected score (related to the number of scored lobes in cases of important lobar condensation or lobectomy) were used. One hundred ninety-two patients were included, for a total of 228 alveolar NT-PCP-III level and CT scan 'couples'. Crude and corrected CT scan fibrosis scores were higher in the fibroproliferation group compared with the no fibroproliferation group (crude score: 12 [9-17] vs 14 [11-12], p?=?0.002; corrected score: 2.8 [2.2-4.0] vs 3.4 [2.5-4.7], p?

SUBMITTER: Hamon A

PROVIDER: S-EPMC6437222 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Chest CT scan and alveolar procollagen III to predict lung fibroproliferation in acute respiratory distress syndrome.

Hamon Annabelle A Scemama Ugo U Bourenne Jérémy J Daviet Florence F Coiffard Benjamin B Persico Nicolas N Adda Mélanie M Guervilly Christophe C Hraiech Sami S Chaumoitre Kathia K Roch Antoine A Papazian Laurent L Forel Jean-Marie JM

Annals of intensive care 20190327 1

<h4>Background</h4>Lung fibroproliferation in ARDS patients is associated with mortality. Alveolar procollagen III (NT-PCP-III) is a validated biomarker of lung fibroproliferation. A chest CT scan could be useful for the diagnosis of lung fibroproliferation. The aim of this study was to identify lung fibroproliferative CT scan aspects in ARDS patients with high levels of NT-PCP-III.<h4>Results</h4>This retrospective study included ARDS patients who had at least one assessment of alveolar NT-PCP- ...[more]

PMID: 30919111

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Project description:BACKGROUND:High frequency percussive ventilation (HFPV) combines diffusive (high frequency mini-bursts) and convective ventilation patterns. Benefits include enhanced oxygenation and hemodynamics, and alveolar recruitment, while providing hypothetic lung-protective ventilation. No study has investigated HFPV-induced changes in lung aeration in patients with early acute respiratory distress syndrome (ARDS). METHODS:Eight patients with early non-focal ARDS were enrolled and five swine with early non-focal ARDS were studied in prospective computed tomography (CT) scan and animal studies, in a university-hospital tertiary ICU and an animal laboratory. Patients were optimized under conventional "open-lung" ventilation. Lung CT was performed using an end-expiratory hold (Conv) to assess lung morphology. HFPV was applied for 1 hour to all patients before new CT scans were performed with end-expiratory (HFPV EE) and end-inspiratory (HFPV EI) holds. Lung volumes were determined after software analysis. At specified time points, blood gases and hemodynamic data were collected. Recruitment was defined as a change in non-aerated lung volumes between Conv, HFPV EE and HFPV EI. The main objective was to verify whether HFPV increases alveolar recruitment without lung hyperinflation. Correlation between pleural, upper airways and HFPV-derived pressures was assessed in an ARDS swine-based model. RESULTS:One-hour HFPV significantly improved oxygenation and hemodynamics. Lung recruitment significantly rose by 12.0% (8.5-18.0%), P?=?0.05 (Conv-HFPV EE) and 12.5% (9.3-16.8%), P?=?0.003 (Conv-HFPV EI). Hyperinflation tended to increase by 2.0% (0.5-2.5%), P?=?0.89 (Conv-HFPV EE) and 3.0% (2.5-4.0%), P?=?0.27 (Conv-HFPV EI). HFPV hyperinflation correlated with hyperinflated and normally-aerated lung volumes at baseline: r?=?0.79, P?=?0.05 and r?=?0.79, P?=?0.05, respectively (Conv-HFPV EE); and only hyperinflated lung volumes at baseline: r?=?0.88, P?=?0.01 (Conv-HFPV EI). HFPV CT-determined tidal volumes reached 5.7 (1.1-8.1) mL.kg-1 of ideal body weight (IBW). Correlations between pleural and HFPV-monitored pressures were acceptable and end-inspiratory pleural pressures remained below 25cmH20. CONCLUSIONS:HFPV improves alveolar recruitment, gas exchanges and hemodynamics of patients with early non-focal ARDS without relevant hyperinflation. HFPV-derived pressures correlate with corresponding pleural or upper airways pressures. TRIAL REGISTRATION:ClinicalTrials.gov, NCT02510105 . Registered on 1 June 2015. The trial was retrospectively registered.

Dataset Information

Chest CT scan and alveolar procollagen III to predict lung fibroproliferation in acute respiratory distress syndrome.

Publications

Chest CT scan and alveolar procollagen III to predict lung fibroproliferation in acute respiratory distress syndrome.

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