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Abstract：
Normally aerated lung tissue on computed tomography (CT) is correlated with static respiratory system compliance (Crs) at zero end-expiratory pressure. In clinical practice, however, patients with acute respiratory failure are often managed using elevated PEEP levels. No study has validated the relationship between lung volume and tissue and Crs at the applied positive end-expiratory pressure (PEEP). Therefore, this study aimed to demonstrate the relationship between lung volume and tissue on CT and Crs during the application of PEEP for the clinical management of patients with acute respiratory distress syndrome due to COVID-19. Additionally, as a secondary outcome, the study aimed to evaluate the relationship between CT characteristics and Crs, considering recruitability using the recruitment-to-inflation ratio (R/I ratio). We analyzed the CT and respiratory mechanics data of 30 patients with COVID-19 who were mechanically ventilated. The CT images were acquired during mechanical ventilation at PEEP level of 15 cmH2O and were quantitatively analyzed using Synapse Vincent system version 6.4 (Fujifilm Corporation, Tokyo, Japan). Recruitability was stratified into two groups, high and low recruitability, based on the median R/I ratio of our study population. Thirty patients were included in the analysis with the median R/I ratio of 0.71. A significant correlation was observed between Crs at the applied PEEP (median 15 [interquartile range (IQR) 12.2, 15.8]) and the normally aerated lung volume (r = 0.70 [95% CI 0.46-0.85], P < 0.001) and tissue (r = 0.70 [95% CI 0.46-0.85], P < 0.001). Multivariable linear regression revealed that recruitability (Coefficient = - 390.9 [95% CI - 725.0 to - 56.8], P = 0.024) and Crs (Coefficient = 48.9 [95% CI 32.6-65.2], P < 0.001) were significantly associated with normally aerated lung volume (R-squared: 0.58). In this study, Crs at the applied PEEP was significantly correlated with normally aerated lung volume and tissue on CT. Moreover, recruitability indicated by the R/I ratio and Crs were significantly associated with the normally aerated lung volume. This research underscores the significance of Crs at the applied PEEP as a bedside-measurable parameter and sheds new light on the link between recruitability and normally aerated lung.
摘要：
计算机断层扫描（CT）上的正常充气肺组织与零呼气末压力下的静态呼吸系统顺应性（Crs）相关。在临床实践中,然而,急性呼吸衰竭患者通常使用升高的PEEP水平进行治疗.在施加呼气末正压（PEEP）时，尚无研究验证肺容积与组织和Crs之间的关系。因此,这项研究旨在证明PEEP用于COVID-19急性呼吸窘迫综合征患者的临床治疗期间，CT和Crs上的肺体积与组织之间的关系。此外,作为次要结果，该研究旨在评估CT特征与Crs之间的关系，使用招聘与通货膨胀率(R/I比率)考虑招聘性。我们分析了30例机械通气的COVID-19患者的CT和呼吸力学数据。在PEEP水平为15cmH2O的机械通气期间获取CT图像，并使用SynapseVincent系统6.4版进行定量分析（FujifilmCorporation，东京,日本）。可招募性被分为两组，招聘能力高低，基于我们研究人群的中位R/I比。30例患者被纳入分析，中位R/I比为0.71。在应用PEEP时观察到Crs（中位数15[四分位距（IQR）12.2，15.8]）与正常充气肺体积之间存在显着相关性（r=0.70[95％CI0.46-0.85]，P<0.001）和组织（r=0.70[95%CI0.46-0.85]，P<0.001)。多变量线性回归显示招聘性(系数=-390.9[95%CI-725.0至-56.8]，P=0.024）和Crs（系数=48.9[95%CI32.6-65.2]，P<0.001）与正常充气肺体积（R平方：0.58）显着相关。在这项研究中,应用PEEP时的Crs与CT上正常充气的肺体积和组织显着相关。此外，R/I比和Crs显示的可招募性与正常充气肺容积显著相关.这项研究强调了Crs在应用PEEP中作为床边可测量参数的重要性，并为招募性与正常充气肺之间的联系提供了新的思路。
