+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Radiographic assessment of hyperinflation: correlation with objective chest radiographic measurements and mechanical ventilator parameters



Radiographic assessment of hyperinflation: correlation with objective chest radiographic measurements and mechanical ventilator parameters



Chest 113(6): 1698-1704



Background: Pulmonary barotrauma is a potentially fatal complication of positive pressure ventilation. We previously found that barotrauma occurred in patients with radiographic hyperinflation but few objective data define the relationships among hyperinflation, objective chest radiograph (CXR) measurements, ventilator parameters, and development of barotrauma. Objectives: We sought (1) to assess the relationships among hyperinflation, objective CXR findings, mechanical ventilator parameters, and development of barotrauma. (2) To compare radiographic hyperinflation, ventilator parameters, and incidence of barotrauma in a current group of ICU patients with historical control subjects. Setting: Medical and surgical ICU patients in a university hospital. Design: Prospective blinded observational study; comparison of current series with historical control subjects. Methods: One hundred two prospectively enrolled mechanically ventilated medical and surgical ICU patients each received portable supine CXRs that were reviewed independently by three radiologists who made objective measurements and subjectively determined the likelihood of hyperinflation. Ventilator parameters were recorded at the bedside at the time each CXR was obtained. CXR measurements and ventilator parameters were then related to the development of barotrauma during the course of ventilation and compared with findings of a prospective study at our institution 1 year earlier. Results: Radiographically recognizable hyperinflation occurred in 18 of 102 mechanically ventilated ICU patients (18%) and correlated with lung length (24.7 vs 19.8 cm; p<0.05) and the anterior rib number that intersects the hemidiaphragm (5.4 vs 4.7; p<0.05). Patients with hyperinflation were ventilated at higher tidal volume per kilogram (VT/kg) (11.0 vs 9.4; p=0.0081), but peak airway pressure, plateau pressure, and positive end-expiratory pressure were similar. There were significant decreases in VT (810 vs 739 mL; p=0.015) and VT/kg (11.0 vs 10.1 mL/kg; p<0.001) in these mechanically ventilated ICU patients in comparison to hospital control subjects evaluated during the previous year. Paralleling these changes was a decrease in the frequency of CXR hyperinflation (p=0.003) and the incidence of ventilator-associated barotrauma (6.5% vs 0.98%; p=0.048). Conclusions: Ventilation at higher VT/kg is associated with a higher incidence of CXR hyperinflation. Radiographic hyperinflation is associated with lung length gtoreq 24.7 cm and visualization of the sixth anterior rib. Patients with hyperinflation may he at greater risk for developing barotrauma or volutrauma. Ventilatory strategies utilizing lower volumes are associated with a lower incidence of such trauma in the current sample as compared with historical control subjects.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 009293231

Download citation: RISBibTeXText

PMID: 9631816


Related references

Portable chest radiographs identify mechanical ventilator-associated hyperinflation. Chest 106(2): 545-551, 1994

Radiographic assessment of cementless femoral components. Correlation with intraoperative mechanical stability. Journal of Arthroplasty 9(2): 137-141, 1994

Correlation of radiographic and MRI parameters to morphological and biochemical assessment of intervertebral disc degeneration. European Spine Journal 14(1): 27-35, 2005

Assessment of the correlation between commonly used radiographic parameters in normal, subluxated and dislocated hips. Journal of Pediatric Orthopedics. Part B 15(3): 172-177, 2006

Radiographic measures of hyperinflation in clinical emphysema. Discrimination of patients from controls and relationship to physiologic and mechanical lung function. Chest 94(5): 907-913, 1988

The effect of mechanical ventilator settings during ventilator hyperinflation techniques: a bench-top analysis. Anaesthesia and Intensive Care 43(1): 81-87, 2015

Objective measurements of radiographic image quality. Zimmerman, Stuart O (Chairman) Ninth Annual Symposium on Biomathematics And Computer Science in The Life Sciences Ix + 115p Illus University Of Texas Graduate School Of Biomedical Sciences, Division Of Continuing Education: Houston, Tex , U S A 46-48, 1971

Chest radiographic presenting features and radiographic progression of pneumocystis pneumonia in South African children. Pediatric Pulmonology 46(10): 1015-1022, 2011

Optimization of chest radiographic imaging parameters: a comparison of image quality and entrance skin dose for digital chest radiography systems. Clinical Imaging 36(4): 279-286, 2012

Chest radiographic appearances in severely burned adults. A comparison of early radiographic and extravascular lung thermal volume changes. Journal of Burn Care and Rehabilitation 22(2): 104-110, 2001

Analysis of feline splenic radiographic measurements and their correlation to ultrasonographic measurements. Journal of Feline Medicine and Surgery 19(10): 985-991, 2017

Correlation between radiographic area and immunolocation of MMP-2 and MMP-9 in unilocular radiographic lesions. Brazilian Dental Journal 25(6): 466-471, 2016

Objective radiographic assessment of pulmonary vascularity in children. Radiology 109(3): 649-654, 1973

Correlation between static radiographic measurements and intersegmental angular measurements during gait using a multisegment foot model. Foot and Ankle International 36(1): 1-10, 2015

Radiographic tracheal diameter measurements in acute infectious croup: an objective scoring system. Critical Care Medicine 9(8): 587-590, 1981