ArticleAmerican journal of respiratory and critical care medicine2018
Unstable Inflation Causing Injury. Insight from Prone Position and Paired Computed Tomography Scans.
Article in American journal of respiratory and critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 36 citations in OpenAlex.
- Obesity: biomechanical implications for mechanical ventilation.Critical care (London, England) · 2026Review
- Characterizing heterogeneity and subphenotyping acute respiratory distress syndrome with computed tomography.Intensive care medicine experimental · 2026Review
- Ventilator-induced lung injury in rat models: are they all equal in the race?Laboratory animal research · 2025Review
- Novel lung imaging techniques: new experimental insights in acute respiratory failure.Intensive care medicine experimental · 2025Article
- Perfusion deficits may underlie lung and kidney injury in severe COVID-19 disease: insights from a multicenter international cohort study.Journal of anesthesia, analgesia and critical care · 2024Review
- Unsupervised segmentation and quantification of COVID-19 lesions on computed Tomography scans using CycleGAN.Methods (San Diego, Calif.) · 2022Article
- Imatinib alleviates lung injury and prolongs survival in ventilated rats.American journal of physiology. Lung cellular and molecular physiology · 2022Article
- Lung response to prone positioning in mechanically-ventilated patients with COVID-19.Critical care (London, England) · 2022Article
- Update on the Features and Measurements of Experimental Acute Lung Injury in Animals: An Official American Thoracic Society Workshop Report.American journal of respiratory cell and molecular biology · 2022Article
- Effects of Lung Injury on Regional Aeration and Expiratory Time Constants: Insights From Four-Dimensional Computed Tomography Image Registration.Frontiers in physiology · 2021Article
- New Frontiers in Functional and Molecular Imaging of the Acutely Injured Lung: Pathophysiological Insights and Research Applications.Frontiers in physiology · 2021Review
- Positional Therapy and Regional Pulmonary Ventilation.Anesthesiology · 2020Article
- Quantitative CT-based image registration metrics provide different ventilation and lung motion patterns in prone and supine positions in healthy subjects.Respiratory research · 2020Article
- Prevention and treatment of acute lung injury with time-controlled adaptive ventilation: physiologically informed modification of airway pressure release ventilation.Annals of intensive care · 2020Review
- Quantifying Regional Lung Deformation Using Four-Dimensional Computed Tomography: A Comparison of Conventional and Oscillatory Ventilation.Frontiers in physiology · 2020Article
- A Physiologically Informed Strategy to Effectively Open, Stabilize, and Protect the Acutely Injured Lung.Frontiers in physiology · 2020Review
- Mechanical Ventilation Lessons Learned From Alveolar Micromechanics.Frontiers in physiology · 2020Review
- Imaging the Injured Lung: Mechanisms of Action and Clinical Use.Anesthesiology · 2019Review
- It Is Time to Treat the Patient and Not Just the Ventilator.Critical care medicine · 2019Article
- The time-controlled adaptive ventilation protocol: mechanistic approach to reducing ventilator-induced lung injury.European respiratory review : an official journal of the European Respiratory Society · 2019Review
Corrections and comments
- Commented on by
Authors and funding
14 authors at 5 institutions in 2 countries.
Funding
Abstract
rationaleIt remains unclear how prone positioning improves survival in acute respiratory distress syndrome. Using serial computed tomography (CT), we previously reported that "unstable" inflation (i.e., partial aeration with large tidal density swings, indicating increased local strain) is associated with injury progression.
objectivesWe prospectively tested whether prone position contains the early propagation of experimental lung injury by stabilizing inflation.
methodsInjury was induced by tracheal hydrochloric acid in rats; after randomization to supine or prone position, injurious ventilation was commenced using high tidal volume and low positive end-expiratory pressure. Paired end-inspiratory (EI) and end-expiratory (EE) CT scans were acquired at baseline and hourly up to 3 hours. Each sequential pair (EI, EE) of CT images was superimposed in parametric response maps to analyze inflation. Unstable inflation was then measured in each voxel in both dependent and nondependent lung. In addition, five pigs were imaged (EI and EE) prone versus supine, before and (1 hour) after hydrochloric acid aspiration. MEASUREMENTS AND MAIN
resultsIn rats, prone position limited lung injury propagation and increased survival (11/12 vs. 7/12 supine; P = 0.01). EI-EE densities, respiratory mechanics, and blood gases deteriorated more in supine versus prone rats. At baseline, more voxels with unstable inflation occurred in dependent versus nondependent regions when supine (41 ± 6% vs. 18 ± 7%; P < 0.01) but not when prone. In supine pigs, unstable inflation predominated in dorsal regions and was attenuated by prone positioning.
conclusionsProne position limits the radiologic progression of early lung injury. Minimizing unstable inflation in this setting may alleviate the burden of acute respiratory distress syndrome.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.