2020年ARDS肺可复张性评估.ppt

A: Consolidated parenchymal area in patient suffering from ARDS. B: The hyperreflectant air aspect reaching the pulmonary consolidation and the progressive reduction of its compactness. C. Recruitment: consolidationis dimensionally reduced and partly replaced by normal air parenchyma, full of “B lines”, an expression of interstitial thickening. * Definition of abbreviations:B15multiple well-defined either regularly spaced 7-mm apart or irregularly spaced B lines (moderate loss of lung aeration); B25 multiple coalescent B lines (severe loss of lung aeration); C5lung consolidation; N5normal pattern (normal lung aeration). * The ultrasound reaeration score was calculated as follows: In a first step, ultrasound lung aeration (N, B1, B2, and C) was assessed in each of the 12 lung regions examined before and after application of positive end-expiratory pressure 15 cm H2O. In a second step, ultrasound lung reaeration score was calculated as the sum of each score characterizing each lung region examined according to the scale shown in the table. * (A)Left: Transversal view of consolidated lower lobe. Lung consolidation appears as a tissue structure (C), and hyperechoic tubular images (*) can be seen, corresponding to dynamic air bronchograms (air-filled bronchi).Right: After PEEP 15 cm H2O, the same lung region appears normally aerated. The pleural line (white arrow) can be seen with multiple horizontal A lines (thin arrows). (B)Left: Transversal view of consolidated lower lobe. Lung consolidation appears as a tissue structure (C), and hyperechoic punctiform images (*) can be seen, corresponding to static air bronchograms (air-filled bronchi).Right: After PEEP 15 cm H2O, the same lung region is characterized by multiple coalescent B lines (B2 lines), attesting to the penetration of gas within the consolidation. The pleural line is visible (white arrow), as well as coalescent B lines (*) arising from the pleural line and spreading up to the edge of the screen. These artifa