Novel Analysis of 4DCT Imaging Quantifies Progressive Increases in Anatomic Dead Space During Mechanical Ventilation in Mice

PURPOSE: Increased dead space is an important prognostic marker in early acute respiratory distress syndrome (ARDS) that correlates with mortality. The cause of increased dead space in ARDS has largely been attributed to increased alveolar dead space due to ventilation/perfusion mismatching and shunt. We sought to determine if anatomic dead space also increases in response to mechanical ventilation.

METHODS: Mice received intratracheal lipopolysaccharide (LPS) or saline and mechanical ventilation (MV). Four-dimensional computed tomography (4DCT) scans were performed at onset of MV and after 5 h of MV. Detailed measurements of airway volumes and lung tidal volumes were performed using image analysis software. The forced oscillation technique was used to obtain measures of airway resistance (Raw), tissue damping (G) and tissue elastance (H).

RESULTS: The ratio of airway volumes to total tidal volume increased significantly in response to 5 h mechanical ventilation, regardless of LPS exposure, and airways demonstrated significant variation in volumes over the respiratory cycle. These findings were associated with an increase in tissue elastance (decreased lung compliance) but without changes in tidal volumes.

CONCLUSIONS: Airway volumes increased over time with exposure to mechanical ventilation without a concomitant increase in tidal volumes. These findings suggest that anatomic dead space fraction increases progressively with exposure to positive pressure ventilation, and may represent a pathological process.