Journal of Clinical Medicine

Editorial

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Open AccessEditorial

Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging

by Gaetano Perchiazzi and Hermann Wrigge

J. Clin. Med. 2019, 8(12), 2171; https://doi.org/10.3390/jcm8122171 - 9 Dec 2019

Cited by 2 | Viewed by 3855

Abstract

Acute respiratory distress syndrome (ARDS) is in the center of the scientific debate both for its complex pathophysiology and for the discussion about the remedies that could contribute to its healing. The intricate interplay of different body systems that characterizes ARDS is mirrored [...] Read more.

Acute respiratory distress syndrome (ARDS) is in the center of the scientific debate both for its complex pathophysiology and for the discussion about the remedies that could contribute to its healing. The intricate interplay of different body systems that characterizes ARDS is mirrored by two main research threads, one centered on the pathophysiological mechanisms of the disease and the other on the new approaches to lung imaging. In this Special Issue of the Journal of Clinical Medicine are presented studies using imaging technologies based on electrical impedance tomography, synchrotron radiation computed tomography and intravital probe-based confocal laser endomicroscopy. The studies on the pathophysiological mechanisms pertain to the evaluation of the biomarkers of the disease and the platelet disfunction during extracorporeal membrane oxygenation. These contributions witness the intensity of ARDS research as many of the key problems of the disease are only in part resolved. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging)

Research

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16 pages, 2351 KiB

Open AccessArticle

Mechanical Ventilation Strategies Targeting Different Magnitudes of Collapse and Tidal Recruitment in Porcine Acid Aspiration-Induced Lung Injury

by Juliane Haase, Dorina C. Buchloh, Sören Hammermüller, Peter Salz, Julia Mrongowius, Nadja C. Carvalho, Alessandro Beda, Anna Rau, Henning Starke, Peter M. Spieth, Claudia Gittel, Thomas Muders, Hermann Wrigge and Andreas W. Reske

J. Clin. Med. 2019, 8(8), 1250; https://doi.org/10.3390/jcm8081250 - 18 Aug 2019

Cited by 9 | Viewed by 5858

Abstract

Reducing ventilator-associated lung injury by individualized mechanical ventilation (MV) in patients with Acute Respiratory Distress Syndrome (ARDS) remains a matter of research. We randomly assigned 27 pigs with acid aspiration-induced ARDS to three different MV protocols for 24 h, targeting different magnitudes of [...] Read more.

Reducing ventilator-associated lung injury by individualized mechanical ventilation (MV) in patients with Acute Respiratory Distress Syndrome (ARDS) remains a matter of research. We randomly assigned 27 pigs with acid aspiration-induced ARDS to three different MV protocols for 24 h, targeting different magnitudes of collapse and tidal recruitment (collapse&TR): the ARDS-network (ARDSnet) group with low positive end-expiratory pressure (PEEP) protocol (permissive collapse&TR); the Open Lung Concept (OLC) group, PaO₂/FiO₂ >400 mmHg, indicating collapse&TR <10%; and the minimized collapse&TR monitored by Electrical Impedance Tomography (EIT) group, standard deviation of regional ventilation delay, SD_RVD. We analyzed cardiorespiratory parameters, computed tomography (CT), EIT, and post-mortem histology. Mean PEEP over post-randomization measurements was significantly lower in the ARDSnet group at 6.8 ± 1.0 cmH₂O compared to the EIT (21.1 ± 2.6 cmH₂O) and OLC (18.7 ± 3.2 cmH₂O) groups (general linear model (GLM) p < 0.001). Collapse&TR and SD_RVD, averaged over all post-randomization measurements, were significantly lower in the EIT and OLC groups than in the ARDSnet group (collapse p < 0.001, TR p = 0.006, SD_RVD p < 0.004). Global histological diffuse alveolar damage (DAD) scores in the ARDSnet group (10.1 ± 4.3) exceeded those in the EIT (8.4 ± 3.7) and OLC groups (6.3 ± 3.3) (p = 0.16). Sub-scores for edema and inflammation differed significantly (ANOVA p < 0.05). In a clinically realistic model of early ARDS with recruitable and nonrecruitable collapse, mechanical ventilation involving recruitment and high-PEEP reduced collapse&TR and resulted in improved hemodynamic and physiological conditions with a tendency to reduced histologic lung damage. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging)

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15 pages, 18703 KiB

Open AccessArticle

A Modified Method to Assess Tidal Recruitment by Electrical Impedance Tomography

by Thomas Muders, Benjamin Hentze, Philipp Simon, Felix Girrbach, Michael R.G. Doebler, Steffen Leonhardt, Hermann Wrigge and Christian Putensen

J. Clin. Med. 2019, 8(8), 1161; https://doi.org/10.3390/jcm8081161 - 3 Aug 2019

Cited by 12 | Viewed by 4074

Abstract

Avoiding tidal recruitment and collapse during mechanical ventilation should reduce the risk of lung injury. Electrical impedance tomography (EIT) enables detection of tidal recruitment by measuring regional ventilation delay inhomogeneity (RVDI) during a slow inflation breath with a tidal volume (V_T) [...] Read more.

Avoiding tidal recruitment and collapse during mechanical ventilation should reduce the risk of lung injury. Electrical impedance tomography (EIT) enables detection of tidal recruitment by measuring regional ventilation delay inhomogeneity (RVDI) during a slow inflation breath with a tidal volume (V_T) of 12 mL/kg body weight (BW). Clinical applicability might be limited by such high V_Ts resulting in high end-inspiratory pressures (P_EI) during positive end-expiratory pressure (PEEP) titration. We hypothesized that RVDI can be obtained with acceptable accuracy from reduced slow inflation V_Ts. In seven ventilated pigs with experimental lung injury, tidal recruitment was quantified by computed tomography at PEEP levels changed stepwise between 0 and 25 cmH₂O. RVDI was measured by EIT during slow inflation V_Ts of 12, 9, 7.5, and 6 mL/kg BW. Linear correlation of tidal recruitment and RVDI was excellent for V_Ts of 12 (R² = 0.83, p < 0.001) and 9 mL/kg BW (R² = 0.83, p < 0.001) but decreased for V_Ts of 7.5 (R² = 0.76, p < 0.001) and 6 mL/kg BW (R² = 0.71, p < 0.001). With any reduction in slow inflation V_T, P_EI decreased at all PEEP levels. Receiver-Operator-Characteristic curve analyses revealed that RVDI-thresholds to predict distinct amounts of tidal recruitment differ when obtained from different slow inflation V_Ts. In conclusion, tidal recruitment can sufficiently be monitored by EIT-based RVDI-calculation with a slow inflation of 9 mL/kg BW. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging)

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9 pages, 1050 KiB

Open AccessArticle

The Role of Exosomes in Bronchoalveloar Lavage from Patients with Acute Respiratory Distress Syndrome

by Tae Hoon Kim, Sang-Bum Hong, Chae-Mann Lim, Younsuck Koh, Eun-young Jang and Jin Won Huh

J. Clin. Med. 2019, 8(8), 1148; https://doi.org/10.3390/jcm8081148 - 1 Aug 2019

Cited by 10 | Viewed by 3950

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a life-threatening condition caused by pulmonary and extrapulmonary insults. Exosomes are considered a major cell-to-cell communicator and immune modulator. However, their role in ARDS remains unclear. In this study, we investigated whether exosomes could be a [...] Read more.

Background: Acute respiratory distress syndrome (ARDS) is a life-threatening condition caused by pulmonary and extrapulmonary insults. Exosomes are considered a major cell-to-cell communicator and immune modulator. However, their role in ARDS remains unclear. In this study, we investigated whether exosomes could be a potential biomarker of ARDS. Methods: We isolated exosomes from bronchoalveolar lavage (BAL) of patients with ARDS. The correlation between the level of exosomes with clinical data, including etiology, oxygenation, and 28-day mortality was analyzed. Enzyme-linked immune sorbent assays and western blotting were carried out to characterize BAL exosomes. Immune modulating response of exosomes was investigated by in vitro examination. Results: From 158 patients, we isolated mean 1568.9 µg/mL BAL exosomes, which presented a negative correlation with the PaO₂/FiO₂ ratio. The level of exosomes did not correlate with 28-day mortality but was elevated in the infectious etiology of ARDS. The exosomes have cargo proteins associated with apoptosis, necroptosis, and autophagy. An in vitro stimulation study revealed that BAL exosomes could induce the production of proinflammatory cytokines and chemokines, but those from patients with ARDS suppressed the production of vascular endothelial growth factor. Conclusions: In ARDS, exosomes are released in alveolar space, and the level is correlated with the etiology of ARDS. BAL exosomes could play an immune-modulating role by controlling the production of cytokines. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging)

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13 pages, 1447 KiB

Open AccessArticle

The Effect of Positive End-Expiratory Pressure on Lung Micromechanics Assessed by Synchrotron Radiation Computed Tomography in an Animal Model of ARDS

by Gaetano Scaramuzzo, Ludovic Broche, Mariangela Pellegrini, Liisa Porra, Savino Derosa, Angela Principia Tannoia, Andrea Marzullo, João Batista Borges, Sam Bayat, Alberto Bravin, Anders Larsson and Gaetano Perchiazzi

J. Clin. Med. 2019, 8(8), 1117; https://doi.org/10.3390/jcm8081117 - 28 Jul 2019

Cited by 8 | Viewed by 3724

Abstract

Modern ventilatory strategies are based on the assumption that lung terminal airspaces act as isotropic balloons that progressively accommodate gas. Phase contrast synchrotron radiation computed tomography (PCSRCT) has recently challenged this concept, showing that in healthy lungs, deflation mechanisms are based on the [...] Read more.

Modern ventilatory strategies are based on the assumption that lung terminal airspaces act as isotropic balloons that progressively accommodate gas. Phase contrast synchrotron radiation computed tomography (PCSRCT) has recently challenged this concept, showing that in healthy lungs, deflation mechanisms are based on the sequential de-recruitment of airspaces. Using PCSRCT scans in an animal model of acute respiratory distress syndrome (ARDS), this study examined whether the numerosity (ASnum) and dimension (ASdim) of lung airspaces change during a deflation maneuver at decreasing levels of positive end-expiratory pressure (PEEP) at 12, 9, 6, 3, and 0 cmH₂O. Deflation was associated with significant reduction of ASdim both in the whole lung section (passing from from 13.1 ± 2.0 at PEEP 12 to 7.6 ± 4.2 voxels at PEEP 0) and in single concentric regions of interest (ROIs). However, the regression between applied PEEP and ASnum was significant in the whole slice (ranging from 188 ± 52 at PEEP 12 to 146.4 ± 96.7 at PEEP 0) but not in the single ROIs. This mechanism of deflation in which reduction of ASdim is predominant, differs from the one observed in healthy conditions, suggesting that the peculiar alveolar micromechanics of ARDS might play a role in the deflation process. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging)

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10 pages, 944 KiB

Open AccessArticle

Platelet Function Disturbance During Veno-Venous ECMO in ARDS Patients Assessed by Multiple Electrode Aggregometry—A Prospective, Observational Cohort Study

by Saskia Wand, Jan Felix Huber-Petersen, Joern Schaeper, Claudia Binder and Onnen Moerer

J. Clin. Med. 2019, 8(7), 1056; https://doi.org/10.3390/jcm8071056 - 19 Jul 2019

Cited by 12 | Viewed by 3047

Abstract

Extracorporeal (veno-venous) membrane oxygenation (vvECMO) has been shown to have negative effects on platelet number and function. This study aimed to gain more information about the impact of vvECMO on platelet function assessed by multiple electrode aggregometry (MEA). Twenty patients with the indication [...] Read more.

Extracorporeal (veno-venous) membrane oxygenation (vvECMO) has been shown to have negative effects on platelet number and function. This study aimed to gain more information about the impact of vvECMO on platelet function assessed by multiple electrode aggregometry (MEA). Twenty patients with the indication for vvECMO were included. Platelet function was analyzed using MEA (Multiplate^®) before (T-1), 6 h (T0), one (T1), two (T2), three (T3), and seven (T4) days after the beginning of vvECMO. Median aggregational measurements were already below the normal reference range before vvECMO initiation. Platelet aggregation was significantly reduced 6 h after vvECMO initiation compared to T-1 and spontaneously recovered with a significant increase at T2. Platelet count dropped significantly between T-1 and T0 and continuously decreased between T0 and T4. At T4, ADP-induced platelet aggregation showed an inverse correlation with the paO2 in the oxygenator. Platelet function should be assessed by MEA before the initiation of extracorporeal circulation. Although ECMO therapy led to a further decrease in platelet aggregation after 6 h, all measurements had recovered to baseline on day two. This implies that MEA as a whole blood method might not adequately reflect the changes in platelet function in the later stages of extracorporeal circulation. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging)

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9 pages, 580 KiB

Open AccessArticle

Longtime Neurologic Outcome of Extracorporeal Membrane Oxygenation and Non Extracorporeal Membrane Oxygenation Acute Respiratory Distress Syndrome Survivors

by Lars-Olav Harnisch, Sebastian Riech, Marion Mueller, Vanessa Gramueller, Michael Quintel and Onnen Moerer

J. Clin. Med. 2019, 8(7), 1020; https://doi.org/10.3390/jcm8071020 - 12 Jul 2019

Cited by 12 | Viewed by 4581

Abstract

Neurologic complications following acute respiratory distress syndrome (ARDS) are well described, however, information on the neurologic outcome regarding peripheral nervous system complications in critically ill ARDS patients, especially those who received extracorporeal membrane oxygenation (ECMO) are lacking. In this prospective observational study 28 [...] Read more.

Neurologic complications following acute respiratory distress syndrome (ARDS) are well described, however, information on the neurologic outcome regarding peripheral nervous system complications in critically ill ARDS patients, especially those who received extracorporeal membrane oxygenation (ECMO) are lacking. In this prospective observational study 28 ARDS patients who survived after ECMO or conventional nonECMO treatment were examined for neurological findings. Nine patients had findings related to cranial nerve innervation, which differed between ECMO and nonECMO patients (p = 0.031). ECMO patients had severely increased patella tendon reflex (PTR) reflex levels (p = 0.027 vs. p = 0.125) as well as gastrocnemius tendon reflex (GTR) (p = 0.041 right, p = 0.149 left) were affected on the right, but not on the left side presumably associated with ECMO cannulation. Paresis (14.3% of patients) was only found in the ECMO group (p = 0.067). Paresthesia was frequent (nonECMO 53.8%, ECMO 62.5%; p = 0.064), in nonECMO most frequently due to initial trauma and polyneuropathy, in the ECMO group mainly due to impairments of N. cutaneus femoris lateralis (4 vs. 0; p = 0.031). Besides well-known central neurologic complications, more subtle complications were detected by thorough clinical examination. These findings are sufficient to hamper activities of daily living and impair quality of life and psychological health and are presumably directly related to ECMO therapy. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging)

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15 pages, 2247 KiB

Open AccessArticle

Early Local Inhibition of Club Cell Protein 16 Following Chest Trauma Reduces Late Sepsis-Induced Acute Lung Injury

by Philipp Störmann, Nils Becker, Jan Tilmann Vollrath, Kernt Köhler, Andrea Janicova, Sebastian Wutzler, Frank Hildebrand, Ingo Marzi and Borna Relja

J. Clin. Med. 2019, 8(6), 896; https://doi.org/10.3390/jcm8060896 - 22 Jun 2019

Cited by 16 | Viewed by 3264

Abstract

Blunt thoracic trauma (TxT) deteriorates clinical post-injury outcomes. Ongoing inflammatory changes promote the development of post-traumatic complications, frequently causing Acute Lung Injury (ALI). Club Cell Protein (CC)16, a pulmonary anti-inflammatory protein, correlates with lung damage following TxT. Whether CC16-neutralization influences the inflammatory course [...] Read more.

Blunt thoracic trauma (TxT) deteriorates clinical post-injury outcomes. Ongoing inflammatory changes promote the development of post-traumatic complications, frequently causing Acute Lung Injury (ALI). Club Cell Protein (CC)16, a pulmonary anti-inflammatory protein, correlates with lung damage following TxT. Whether CC16-neutralization influences the inflammatory course during ALI is elusive. Ninety-six male CL57BL/6N mice underwent a double hit model of TxT and cecal ligation puncture (CLP, 24 h post-TxT). Shams underwent surgical procedures. CC16 was neutralized by the intratracheal application of an anti-CC16-antibody, either after TxT (early) or following CLP (late). Euthanasia was performed at 6 or 24 h post-CLP. Systemic and pulmonary levels of IL-6, IL-1β, and CXCL5 were determined, the neutrophils were quantified in the bronchoalveolar lavage fluid, and histomorphological lung damage was assessed. ALI induced a significant systemic IL-6 increase among all groups, while the local inflammatory response was most prominent after 24 h in the double-hit groups as compared to the shams. Significantly increased neutrophilic infiltration upon double hit was paralleled with the enhanced lung damage in all groups as compared to the sham, after 6 and 24 h. Neutralization of CC16 did not change the systemic inflammation. However, early CC16-neutralization increased the neutrophilic infiltration and lung injury at 6 h post-CLP, while 24 h later, the lung injury was reduced. Late CC16-neutralization increased neutrophilic infiltration, 24 h post-CLP, and was concurrent with an enhanced lung injury. The data confirmed the anti-inflammatory potential of endogenous CC16 in the murine double-hit model of ALI. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging)

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16 pages, 714 KiB

Open AccessArticle

Predicting the Impact of Diffuse Alveolar Damage through Open Lung Biopsy in Acute Respiratory Distress Syndrome—The PREDATOR Study

by Pablo Cardinal-Fernandez, Guillermo Ortiz, Chih-Hao Chang, Kuo-Chin Kao, Emmanuelle Bertreau, Carole Philipponnet, Víctor Manuel Casero-Alonso, Bertrand Souweine, Emmanuel Charbonney and Claude Guérin

J. Clin. Med. 2019, 8(6), 829; https://doi.org/10.3390/jcm8060829 - 11 Jun 2019

Cited by 12 | Viewed by 3911

Abstract

The aim of this retrospective and international study is to identify those clinical variables associated with diffuse alveolar damage (DAD), and to explore the impact of DAD on hospital mortality risk. Inclusion criteria were: adult patients with acute respiratory distress syndrome (ARDS) undergoing [...] Read more.

The aim of this retrospective and international study is to identify those clinical variables associated with diffuse alveolar damage (DAD), and to explore the impact of DAD on hospital mortality risk. Inclusion criteria were: adult patients with acute respiratory distress syndrome (ARDS) undergoing open lung biopsy (OLB) during their intensive care unit (ICU) management. The main end-points were: DAD and hospital mortality. In the training (n = 193) and validation cohorts (n = 65), the respiratory rate (odd ratio (OR) 0.956; confidence interval (CI) 95% 0.918; 0.995) and coronary ischemia (OR 5.974; CI95% 1.668; 21.399) on the day of ARDS had an average area under the receiver operating characteristic curve (AUROC) of 0.660 (CI95% 0.585; 0.736) and 0.562 (0.417; 0.706), respectively. PEEP (OR 1.131; CI95% 1.051; 1.218) and coronary ischemia (OR 6.820; CI95% 1.856; 25.061) on the day of OLB had an average AUROC of 0.696 (CI95% 0.621; 0.769) and 0.534 (CI95% 0.391; 0.678), respectively, to predict DAD. DAD (OR 2.296; CI95% 1.228; 4.294), diabetes mellitus requiring insulin (OR 0.081; CI95% 0.009; 0.710) and the respiratory rate (OR 1.045; CI95% 1.001; 1.091) on the day of ARDS had an average AUROC of 0.659 (CI95% 0.583; 0.737) and 0.513 (CI95% 0.361; 0.664) to predict hospital mortality and DAD (OR 2.081; CI95% 1.053; 4.114), diabetes mellitus requiring insulin (OR 0.093; CI95% 0.009; 0.956), PaCO₂ (OR 1.051; CI95% 1.019; 1.084), and platelets count (OR 0.999; CI95% 0.999; 0.999) the day of OLB had an average AUROC of 0.778 (CI95% 0.710; 0.843) and 0.634 (CI95%0.481; 0.787) to predict hospital mortalty in the training and validation cohorts, respectively. In conclusion, DAD could not to be predicted clinically and was significantly associated with hospital mortality. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging)

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Review

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Open AccessReview

In Vivo Endomicroscopy of Lung Injury and Repair in ARDS: Potential Added Value to Current Imaging

by Olivier Lesur, Frédéric Chagnon, Réjean Lebel and Martin Lepage

J. Clin. Med. 2019, 8(8), 1197; https://doi.org/10.3390/jcm8081197 - 11 Aug 2019

Cited by 13 | Viewed by 3832

Abstract

Background: Standard clinical imaging of the acute respiratory distress syndrome (ARDS) lung lacks resolution and offers limited possibilities in the exploration of the structure–function relationship, and therefore cannot provide an early and clear discrimination of patients with unexpected diagnosis and unrepair profile. The [...] Read more.

Background: Standard clinical imaging of the acute respiratory distress syndrome (ARDS) lung lacks resolution and offers limited possibilities in the exploration of the structure–function relationship, and therefore cannot provide an early and clear discrimination of patients with unexpected diagnosis and unrepair profile. The current gold standard is open lung biopsy (OLB). However, despite being able to reveal precise information about the tissue collected, OLB cannot provide real-time information on treatment response and is accompanied with a complication risk rate up to 25%, making longitudinal monitoring a dangerous endeavor. Intravital probe-based confocal laser endomicroscopy (pCLE) is a developing and innovative high-resolution imaging technology. pCLE offers the possibility to leverage multiple and specific imaging probes to enable multiplex screening of several proteases and pathogenic microorganisms, simultaneously and longitudinally, in the lung. This bedside method will ultimately enable physicians to rapidly, noninvasively, and accurately diagnose degrading lung and/or fibrosis without the need of OLBs. Objectives and Methods: To extend the information provided by standard imaging of the ARDS lung with a bedside, high-resolution, miniaturized pCLE through the detailed molecular imaging of a carefully selected region-of-interest (ROI). To validate and quantify real-time imaging to validate pCLE against OLB. Results: Developments in lung pCLE using fluorescent affinity- or activity-based probes at both preclinical and clinical (first-in-man) stages are ongoing—the results are promising, revealing correlations with OLBs in problematic ARDS. Conclusion: It can be envisaged that safe, high-resolution, noninvasive pCLE with activatable fluorescence probes will provide a “virtual optical biopsy” and will provide decisive information in selected ARDS patients at the bedside. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging)

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19 pages, 2228 KiB

Open AccessReview

Electrical Impedance Tomography for Cardio-Pulmonary Monitoring

by Christian Putensen, Benjamin Hentze, Stefan Muenster and Thomas Muders

J. Clin. Med. 2019, 8(8), 1176; https://doi.org/10.3390/jcm8081176 - 7 Aug 2019

Cited by 100 | Viewed by 12385

Abstract

Electrical impedance tomography (EIT) is a bedside monitoring tool that noninvasively visualizes local ventilation and arguably lung perfusion distribution. This article reviews and discusses both methodological and clinical aspects of thoracic EIT. Initially, investigators addressed the validation of EIT to measure regional ventilation. [...] Read more.

Electrical impedance tomography (EIT) is a bedside monitoring tool that noninvasively visualizes local ventilation and arguably lung perfusion distribution. This article reviews and discusses both methodological and clinical aspects of thoracic EIT. Initially, investigators addressed the validation of EIT to measure regional ventilation. Current studies focus mainly on its clinical applications to quantify lung collapse, tidal recruitment, and lung overdistension to titrate positive end-expiratory pressure (PEEP) and tidal volume. In addition, EIT may help to detect pneumothorax. Recent studies evaluated EIT as a tool to measure regional lung perfusion. Indicator-free EIT measurements might be sufficient to continuously measure cardiac stroke volume. The use of a contrast agent such as saline might be required to assess regional lung perfusion. As a result, EIT-based monitoring of regional ventilation and lung perfusion may visualize local ventilation and perfusion matching, which can be helpful in the treatment of patients with acute respiratory distress syndrome (ARDS). Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging)

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12 pages, 1050 KiB

Open AccessReview

Biomarkers of Acute Lung Injury The Individualized Approach: for Phenotyping, Risk Stratification and Treatment Surveillance

by Daniel D. Murray, Theis Skovsgaard Itenov, Pradeesh Sivapalan, Josefin Viktoria Eklöf, Freja Stæhr Holm, Philipp Schuetz and Jens Ulrik Jensen

J. Clin. Med. 2019, 8(8), 1163; https://doi.org/10.3390/jcm8081163 - 3 Aug 2019

Cited by 22 | Viewed by 3968

Abstract

Do we need biomarkers of lung damage and infection: For what purpose and how should they be used properly? Biomarkers of lung damage can be used for diagnosis, risk stratification/prediction, treatment surveillance and adjustment of targeted therapy. Additionally, novel “omics” methods may offer [...] Read more.

Do we need biomarkers of lung damage and infection: For what purpose and how should they be used properly? Biomarkers of lung damage can be used for diagnosis, risk stratification/prediction, treatment surveillance and adjustment of targeted therapy. Additionally, novel “omics” methods may offer a completely different and effective way of improving the understanding of pathogenesis of lung damage and a way to develop new candidate lung damage biomarkers. In the current review, we give an overview within the field of acute lung damage of (i) disease mechanism biomarkers, (ii) of “ready to use” evidence-based biomarker-guided lung infection management, (iii) of novel strategies of inflammatory phenotyping and how this can be used to tailor corticosteroid treatment, (iv) a future perspective of where “omics” technologies and mindsets may become increasingly important in developing new strategies for treatment and for understanding the development of acute lung damage. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Pathophysiological Insights and Lung Imaging)

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