Imaging inflammation in acute lung injury.

摘要

COMPUTED tomographic imaging provided key early insights into the pathophysiology of adult respiratory distress syndrome and acute lung injury, highlighting the heterogeneity of tissue involvement as a hallmark characteristic and demonstrating the effects of positive end-expiratory pressure (PEEP) and tidal volume on lung recruitment and regional overdistension. These observations generated a rationale for management with PEEP and limited tidal volumes that has been refined and validated through years of basic and clinical studies. It is generally accepted that regional mechanical stresses due to "injurious" mechanical ventilation-primarily overdistension and cyclic airspace opening and closing-are associated with inflammatory processes that induce or exacerbate preexisting lung injury. However, the precise mechanisms by which this occurs or even which mechanical events are primarily responsible have not been defined. In this issue of Anesthesiology, Musch et al.