Visual anatomical lung CT scan assessment of lung recruitability

Davide Chiumello, Antonella Marino, Matteo Brioni, Federica Menga, Irene Cigada, Marco Lazzerini, Maria C. Andrisani, Pietro Biondetti, Bruno Cesana, Luciano Gattinoni

Research output: Contribution to journalArticlepeer-review


Purpose: The computation of lung recruitability in acute respiratory distress syndrome (ARDS) is advocated to set positive end-expiratory pressure (PEEP) for preventing lung collapse. The quantitative lung CT scan, obtained by manual image processing, is the reference method but it is time consuming. The aim of this study was to evaluate the accuracy of a visual anatomical analysis compared with a quantitative lung CT scan analysis in assessing lung recruitability. Methods: Fifty sets of two complete lung CT scans of ALI/ARDS patients computing lung recruitment were analyzed. Lung recruitability computed at an airway pressure of 5 and 45 cmH2O was defined as the percentage decrease in the collapsed/consolidated lung parenchyma assessed by two expert radiologists using a visual anatomical analysis and as the decrease in not aerated lung regions using a quantitative analysis computed by dedicated software. Results: Lung recruitability was 11.3 % (interquartile range 7.39-16.41) and 15.5 % (interquartile range 8.18-21.43) with the visual anatomical and quantitative analysis, respectively. In the Bland-Altman analysis, the bias and agreement bands between the visual anatomical and quantitative analysis were -2.9 % (-11.8 to +5.9 %). The ROC curve showed that the optimal cutoff values for the visual anatomical analysis in predicting high versus low lung recruitability was 8.9 % (area under the ROC curve 0.9248, 95 % CI 0.8550-0.9946). Considering this cutoff, the sensitivity, specificity, and diagnostic accuracy were 0.96, 0.76, and 0.86, respectively. Conclusions: Visual anatomical analysis can classify patients into those with high and low lung recruitability allowing more intensivists to get access to lung recruitability assessment.

Original languageEnglish
Pages (from-to)66-73
Number of pages8
JournalIntensive Care Medicine
Issue number1
Publication statusPublished - Jan 2013


  • ARDS
  • Lung CT scan
  • Lung overdistension
  • Lung recruitability
  • Mechanical ventilation
  • PEEP

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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