Progress of asymmetrical lung injury diagnoses and treatment

doi:10.3877/cma.j.issn.2096-1537.2024.03.013

Abstract

Abstract:

Asymmetrical lung injury refers to the heterogeneous lung injury in the left and right lungs, which is different from the common lung injury characterized by the heterogeneity of anteroposterior gravity gradient. Asymmetrical lung injury, with its particularities in terms of pathophysiological features and respiratory mechanics, has received recent attention. This review focuses on the epidemiology, common causes, diagnosis, respiratory mechanics characteristics, application of electrical impedance tomography and therapy for asymmetric lung injury, with the hope of promoting understanding and further research into this type of lung damage and providing targeted treatment for this group of patients.

Key words: Asymmetrical lung injury, Electrical impedance tomography, Positive end-expiratory pressure, Airway opening pressure

Xiaotong Sun, Huaiwu He. Progress of asymmetrical lung injury diagnoses and treatment[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(03): 287-291.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2024.03.013

https://icu.cma-cmc.com.cn/EN/Y2024/V10/I03/287

Figures/Tables 1

References 28

1	Pham T, Pesenti A, Bellani G, et al. Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study [J]. Eur Respir J, 2021, 57(6): 2003317.
2	Liapikou A, Cillóniz C, Gabarrús A, et al. Multilobar bilateral and unilateral chest radiograph involvement: implications for prognosis in hospitalised community-acquired pneumonia [J]. Eur Respir J, 2016, 48(1): 257-261.
3	Raghavendran K, Nemzek J, Napolitano LM, et al. Aspiration-induced lung injury [J]. Crit Care Med, 2011, 39(4): 818-826.
4	Chowdhury RA, Azad AK, Sardar H, et al. Pattern of pulmonary involvement and outcome of aspiration pneumonia in patients with altered consciousness admitted in Dhaka Medical College Hospital [J]. Mymensingh Med J, 2016, 25(1): 132-137.
5	Wu H, Zhao X. Pulmonary aspiration only increases the risk of right-sided pneumonia in children: comparison of salivagrams and chest radiographs [J]. Nucl Med Commun, 2018, 39(6): 505-510.
6	Mandell LA, Niederman MS. Aspiration pneumonia [J]. N Engl J Med, 2019, 380(7): 651-663.
7	Rendeki S, Molnár TF. Pulmonary contusion [J]. J Thorac Dis, 2019, 11(Suppl 2): S141-S51.
8	Padley SP, Jordan SJ, Goldstraw P, et al. Asymmetric ARDS following pulmonary resection: CT findings initial observations [J]. Radiology, 2002, 223(2): 468-473.
9	Ibañez J, Raurich JM, Abizanda R, et al. The effect of lateral positions on gas exchange in patients with unilateral lung disease during mechanical ventilation [J]. Intensive Care Med, 1981, 7(5): 231-234.
10	Kim MJ, Hwang HJ, Song HH. A randomized trial on the effects of body positions on lung function with acute respiratory failure patients [J]. Int J Nurs Stud, 2002, 39(5): 549-555.
11	Rozé H, Boisselier C, Bonnardel E, et al. Electrical impedance tomography to detect airway closure heterogeneity in asymmetrical acute respiratory distress syndrome [J]. Am J Respir Crit Care Med, 2021, 203(4): 511-515.
12	Carlon GC, Ray C Jr, Klein R, et al. Criteria for selective positive end-expiratory pressure and independent synchronized ventilation of each lung [J]. Chest, 1978, 74(5): 501-507.
13	Gattinoni L, Caironi P, Cressoni M, et al. Lung recruitment in patients with the acute respiratory distress syndrome [J]. N Engl J Med, 2006, 354(17): 1775-1786.
14	Cornejo RA, Díaz JC, Tobar EA, et al. Effects of prone positioning on lung protection in patients with acute respiratory distress syndrome [J]. Am J Respir Crit Care Med, 2013, 188(4): 440-448.
15	Puybasset L, Cluzel P, Chao N, et al. A computed tomography scan assessment of regional lung volume in acute lung injury. The CT Scan ARDS Study Group [J]. Am J Respir Crit Care Med, 1998, 158(5 Pt 1): 1644-1655.
16	Mayo PH, Copetti R, Feller-Kopman D, et al. Thoracic ultrasonography: a narrative review [J]. Intensive Care Med, 2019, 45(9): 1200-1211.
17	Schreiber T, Hueter L, Gaser E, et al. PEEP has beneficial effects on inflammation in the injured and no deleterious effects on the noninjured lung after unilateral lung acid instillation [J]. Intensive Care Med, 2006, 32(5): 740-749.
18	Schortgen F, Bouadma L, Joly-Guillou ML, et al. Infectious and inflammatory dissemination are affected by ventilation strategy in rats with unilateral pneumonia [J]. Intensive Care Med, 2004, 30(4): 693-701.
19	Bastia L, Engelberts D, Osada K, et al. Role of positive end-expiratory pressure and regional transpulmonary pressure in asymmetrical lung injury [J]. Am J Respir Crit Care Med, 2021, 203(8): 969-976.
20	Chen L, Del Sorbo L, Grieco DL, et al. Airway closure in acute respiratory distress syndrome: an underestimated and misinterpreted phenomenon [J]. Am J Respir Crit Care Med, 2018, 197(1): 132-136.
21	Scaramuzzo G, Spadaro S, Waldmann AD, et al. Heterogeneity of regional inflection points from pressure-volume curves assessed by electrical impedance tomography [J]. Crit Care, 2019, 23(1): 119.
22	Cinnella G, Dambrosio M, Brienza N, et al. Independent lung ventilation in patients with unilateral pulmonary contusion. Monitoring with compliance and EtCO₂ [J]. Intensive Care Med, 2001, 27(12): 1860-1867.
23	Perier F, Tuffet S, Maraffi T, et al. Effect of positive end-expiratory pressure and proning on ventilation and perfusion in COVID-19 acute respiratory distress syndrome [J]. Am J Respir Crit Care Med, 2020, 202(12): 1713-1717.
24	Wang YX, Zhong M, Dong MH, et al. Prone positioning improves ventilation-perfusion matching assessed by electrical impedance tomography in patients with ARDS: a prospective physiological study [J]. Crit Care, 2022, 26(1): 154.
25	Slobod D, Spinelli E, Scaramuzzo G, et al. Redistribution of perfusion by prone positioning improves shunt in a patient with unilateral lung injury [J]. Am J Respir Crit Care Med, 2022, 206(12): e76-e78.
26	Meli A, Barbeta Viñas E, Battaglini D, et al. Lateral position during severe mono-lateral pneumonia: an experimental study [J]. Sci Rep, 2020, 10(1): 19372.
27	Thomas PJ, Paratz JD. Is there evidence to support the use of lateral positioning in intensive care? A systematic review [J]. Anaesth Intensive Care, 2007, 35(2): 239-255.
28	Geilen J, Kainz M, Zapletal B, et al. Unilateral acute lung injury in pig: a promising animal model [J]. J Transl Med, 2022, 20(1): 548.

[1]	Jing Lin, Jialong Chen, Dansen Wu, Xiuhua Li, Xiaolan Guo, Songjing Shi. Effect of electrical impedance tomography guided positive end-expiratory pressure titration on patients with acute respiratory distress syndrome / acute respiratory failure: a meta-analysis [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(03): 226-231.
[2]	Yixi Zou, Jinsong Liu, Mi Chen, Fangjiong Huang. Clinical value of the positive end-expiratory pressure volume test in evaluating fluid responsiveness in patients with off-pump coronary artery bypass grafting [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(02): 85-90.
[3]	Fang Sun, Wenhao Zhang, Cui Zhang, Yi Zhao, Xiang Qi, Yongming Chen, Xinwei Mu. Esophageal pressure-guided ventilation in postoperative hypoxemia patients with acute Stanford type A aortic dissection [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2018, 11(03): 168-173.
[4]	Siyi Yuan, Huaiwu He, Yun Long. PEEP titration in ARDS: from oxygenation and compliance to EIT-guided regional respiratory physiology parameters [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(02): 102-107.
[5]	Jingjing Wang, Hui Xie, Puyu Deng, Chenchen Zhang, Xue Tian, Yun Xie, Ruilan Wang. Prone positioning improves ventilation distribution and ventilation-perfusion matching assessed by electrical impedance tomography in COVID-19 patients with ARDS [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(01): 31-37.
[6]	Mengru Xu, Huaiwu He, Yi Chi, Xiaotong Sun, Yun Long, Zhanqi Zhao. Study of reference range for lung ventilation parameters measured by electrical impedance tomography in Chinese health adults [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(04): 360-367.
[7]	Jingjing Wang, Hui Xie, Ruilan Wang. Development status of electrical impedance tomography for monitoring prone position ventilation [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(01): 35-39.
[8]	Yumei Wang, Yan Wang, Yimin Zhou, Mingyue Miao, Yanlin Yang, Linlin Zhang, Ming Xu, Jianxin Zhou. Application of regional recruitment-to-inflation ratio monitored by electrical impedance tomography in the models of acute respiratory distress syndrome [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(04): 360-366.
[9]	Yi Chi, Huaiwu He, Yun Long. Respiratory pendelluft in critically ill patients [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(01): 62-66.
[10]	Runshi Zhou, Yun Long, Zunzhu Li, Qi Li, Wei Han, Siyi Yuan, Yunjie Yang. Study on monitoring lung ventilation during early mobilization in ARDS patients with difficulty of weaning from mechanical ventilation based on electrical impedance tomography technology [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(04): 319-325.
[11]	Mengchun Liu, Jinyan Xing. Electrical impedance tomography in lung imaging of the respiratory system [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(04): 373-378.
[12]	Chun Pan, Yuan Xu, Yi Yang. High-flow nasal cannula oxygen therapy for respiratory failure in a post-esophagectomy patient: A case report [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(02): 203-206.
[13]	Yi Chi, Huaiwu He, Siyi Yuan, Zhanqi Zhao, Yun Long. Application of regional mechanical power monitored by electrical impedance tomography during positive end-expiratory pressure titration in acute respiratory distress syndrome patients [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(02): 115-119.
[14]	Chenglong Liang, Qin Sun, Chun Pan, Jianfeng Xie, Yi Yang. Effect of positive end-expiratory pressure on the central venous pressure of patients with different respiratory system compliance [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2018, 04(03): 245-250.
[15]	Feiping Xia, Ling Liu. Efffect of neurally adjusted ventilatory assist on work of breathing in patients with acute exacerbation of chronic obstructive pulmonary disease [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2016, 02(04): 277-284.

Please choose a citation manager

Content to export