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Looking closer at acute respiratory distress syndrome

the role of advanced imaging techniques

Bellani, Giacomo; Rouby, Jean-Jaques; Constantin, Jean-Michel; Pesenti, Antonio

Current Opinion in Critical Care: February 2017 - Volume 23 - Issue 1 - p 30–37
doi: 10.1097/MCC.0000000000000380
RESPIRATORY SYSTEM: Edited by B. Taylor Thompson
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Purpose of review Advanced imaging techniques have provided invaluable insights in understanding of acute respiratory distress syndrome (ARDS) and the effect of therapeutic strategies, thanks to the possibility of gaining regional information and moving from simple ‘anatomical’ information to in-vivo functional imaging.

Recent findings Computed tomography (CT) led to the understanding of several ARDS mechanisms and interaction with mechanical ventilation. It is nowadays frequently part of routine diagnostic workup, often leading to treatment changes. Moreover, CT is a reference for novel techniques both in clinical and preclinical studies. Bedside transthoracic lung ultrasound allows semiquantitative regional analysis of lung aeration, identifies ARDS lung morphology and response to therapeutic maneuvers. Electrical impedance tomography is a radiation-free, functional, bedside, imaging modality which allows a real-time monitoring of regional ventilation. Finally, positron emission tomography (PET) is a functional imaging technique that allows to trace physiologic processes, by administration of a radioactive molecule. PET with 18FDG has been applied to patients with ARDS, thanks to its ability to track the inflammatory cells activity.

Summary Progresses in lung imaging are key to individualize therapy, diagnosis, and pathophysiological mechanism at play in any patient at any specified time, helping to move toward personalized medicine for ARDS.

aDepartment of Medicine and Surgery, University of Milan-Bicocca

bDepartment of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy

cMultidisciplinary Intensive Care Unit, Department of Anesthesia and Critical Care, Pitie-Salpêtrière Hospital, Assistance Publique Hopitaux de Paris, University School of Medicine Pierre and Marie Curie, UPMC (University Paris-6), Paris

dIntensive Care Unit, Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Centre Hospitalo-Universitaire de Clermont-Ferrand, Clermont Université, Université d’Auvergne, France

eDipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico and Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy

Correspondence to Antonio Pesenti, Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Via F. Sforza 35, 20122 Milano, Italy. Tel: +39 02 5503 3232; fax: +39 02 5503 3230; e-mail: antonio.pesenti@unimi.it

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