Computed tomography scan assessment of lung volume and recruitment during high-frequency oscillatory ventilation

OBJECTIVE: This review describes how computed tomography has increased our understanding of the pathophysiology of acute respiratory distress syndrome. It summarizes current knowledge about lung volume changes and alveolar recruitment during high-frequency oscillatory ventilation (HFOV) assessed by computed tomography (CT), outlines potential problems when comparing HFOV with conventional ventilation (CV) as a result of the different pressure-time profiles, and describes future research directions. DATA SOURCE: CT allows accurate assessment of total lung volumes and differentiation between overinflated, normally aerated, poorly aerated, and nonaerated lung regions. It allows for classification of different patterns of consolidation and may be predictive for the potential for recruitment. DATA SUMMARY: Experimental data suggest that HFOV at mean airway pressures (mPaw) set according to a static PV curve leads to effective lung recruitment but results in overall lung volumes that are considerably higher than those predicted from the PV relationship. In saline-lavaged sheep, similar changes in total lung volumes and subvolumes were observed during HFOV and CV. One single study specifically assessed lung volume recruitment during HFOV as compared with CV in eight patients with acute respiratory distress syndrome from pneumonia or sepsis. After 48 hrs on HFOV, total ventilated lung volume was significantly increased, whereas only a minor increase in overinflated lung volume was observed. These changes correlated with a significant improvement in gas exchange. CONCLUSION: CT is a valuable tool to quantify recruitment and overinflation during HFOV. Additional studies are needed to better characterize the specific effects of HFOV on lung volume and morphology.