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Yang L, Dai M, Cao X, Möller K, Dargvainis M, Frerichs I, Becher T, Fu F, Zhao Z. Regional ventilation distribution in healthy lungs: can reference values be established for electrical impedance tomography parameters? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:789. [PMID: 34268402 PMCID: PMC8246208 DOI: 10.21037/atm-20-7442] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/24/2021] [Indexed: 12/26/2022]
Abstract
Background Although electrical impedance tomography (EIT) is widely used for monitoring regional ventilation distribution, reference values have yet to be established for clinical use. The present study aimed to evaluate the feasibility of creating reference values for standard EIT parameters for potential clinical application. Methods A total of 75 participants with healthy lungs were included in this prospective study (male:female, 48:27; age, 34±14 years; height, 172±7 cm; weight, 73±12 kg). The subjects were examined during spontaneous breathing in the supine position. EIT measurements were performed at the level of the 4th intercostal space. Commonly used EIT-based parameters, including the center of ventilation (CoV), dorsal and most dorsal fractions of ventilation distribution (TVD and TVROI4 respectively), global inhomogeneity (GI) index, and standard deviation of regional ventilation delay index (RVDSD) were calculated. Results Following outlier detection, EIT data from 71 subjects were finally evaluated. The values of the evaluated parameters were: CoV, 48.7%±1.7%; TVD, 48.1%±5.4%; TVROI4, 7.1%±1.8%; GI, 0.49±0.04; and RVDSD, 7.0±2.0. The coefficients of variation for CoV and GI were low (0.03 and 0.07, respectively), but those for TVROI4 and RVDSD were comparatively high (0.26 and 0.28, respectively). None of the evaluated parameters showed a significant correlation with age. The GI index showed a weak but significant correlation with body mass index (R=0.29, P=0.01). The RVDSD was slightly higher in males than in females. Conclusions Our study indicated that CoV and GI were stable parameters with small coefficients of variation in participants with healthy lungs. The creation of EIT parameter reference values for setting treatment targets may be feasible.
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Affiliation(s)
- Lin Yang
- Department of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Meng Dai
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Xinsheng Cao
- Department of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Knut Möller
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Mantas Dargvainis
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Tobias Becher
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Feng Fu
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.,Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
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Shin K, Ahmad SU, Mueller JL. A Three Dimensional Calderon-Based Method for EIT on the Cylindrical Geometry. IEEE Trans Biomed Eng 2021; 68:1487-1495. [PMID: 33206600 PMCID: PMC8109182 DOI: 10.1109/tbme.2020.3039197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Electrical impedance tomography (EIT) is an imaging modality in which voltage data arising from currents applied on the boundary are used to reconstruct the conductivity distribution in the interior. This paper provides a novel direct (noniterative) 3-D reconstruction algorithm for EIT in the cylindrical geometry. METHODS The algorithm is based on Calderón's method [Calderón, 1980], and is implemented for data collected on two or four rows of electrodes on the boundary of a cylinder. RESULTS The effectiveness of the method to localize inhomogeneities in the plane of the electrodes and in the z-direction is demonstrated on simulated and experimental data. CONCLUSIONS AND SIGNIFICANCE The results from simulated and experimental data show that the method is effective for distinguishing in-plane and nearby out-of-plane inhomogeneities with good spatial resolution in the vertical z direction with computational efficiency.
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253
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Longhini F, Pelaia C, Garofalo E, Bruni A, Placida R, Iaquinta C, Arrighi E, Perri G, Procopio G, Cancelliere A, Rovida S, Marrazzo G, Pelaia G, Navalesi P. High-flow nasal cannula oxygen therapy for outpatients undergoing flexible bronchoscopy: a randomised controlled trial. Thorax 2021; 77:58-64. [PMID: 33927023 DOI: 10.1136/thoraxjnl-2021-217116] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION High-flow nasal cannula (HFNC) provides benefits to patients undergoing flexible bronchoscopy (FOB). We compared the effects of HFNC versus standard therapy (ST) on gas exchange, lung volume and diaphragm function in patients undergoing FOB for bronchoalveolar lavage (BAL). METHODS 36 outpatients were randomised to ST or HFNC. Arterial blood gases, episodes of severe desaturation, changes of end-expiratory lung impedance (ΔEELI), diaphragm ultrasound were recorded. Measurements were done at baseline (T0), after bronchoscope insertion (T1), at the end of the procedure (T2) and 10 min afterwards (T3). RESULTS Arterial partial oxygen pressure (PaO2) was not different between T0 (10.8 (95% CI 8.7 to 12.0) kPa and T2 (11.1 (95% CI 10.4 to 12.0) kPa) with HFNC, while decreased from 11.1 (95% CI 10.5 to 12.1) to 9.1 (95% CI 8.4 to 9.8) kPa with ST. At T2, PaO2 was significantly higher with HFNC than with ST (p<0.001). Also, with HFNC, compared with ST, fewer desaturations occurred (11% vs 56%; p<0.01). ΔEELI was no different at the different time points with HFNC, while with ST there was a significant decrease at T1 (-170 (95% CI -382 to -32) mL, p=0.003), T2 (-211 (95% CI -425 to -148) mL, p<0.001) and T3 (-213 (95% CI -398 to -81) mL, p<0.001), as opposed to T0. EELI was lower with ST than HFNC at T1 (p=0.006), T2 (p=0.001) and T3 (p=0.002). Diaphragm displacement was no different between groups (p=0.748), while the thickening fraction significantly increased at T1 and T2 with ST only (p<0.01). CONCLUSIONS During FOB for BAL, HFNC improves gas exchange, avoiding loss of end-expiratory lung volume and preventing increase of diaphragm activation. TRIAL REGISTRATION NUMBER NCT04016480.
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Affiliation(s)
- Federico Longhini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Corrado Pelaia
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Andrea Bruni
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Roberta Placida
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Caterina Iaquinta
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Arrighi
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Graziella Perri
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giada Procopio
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Anna Cancelliere
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | | | | | - Girolamo Pelaia
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Paolo Navalesi
- Department of Translational Medicine, University of Padua, Padova, Italy
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Abstract
PURPOSE OF REVIEW Among noninvasive lung imaging techniques that can be employed at the bedside electrical impedance tomography (EIT) and lung ultrasound (LUS) can provide dynamic, repeatable data on the distribution regional lung ventilation and response to therapeutic manoeuvres.In this review, we will provide an overview on the rationale, basic functioning and most common applications of EIT and Point of Care Ultrasound (PoCUS, mainly but not limited to LUS) in the management of mechanically ventilated patients. RECENT FINDINGS The use of EIT in clinical practice is supported by several studies demonstrating good correlation between impedance tomography data and other validated methods of assessing lung aeration during mechanical ventilation. Similarly, LUS also correlates with chest computed tomography in assessing lung aeration, its changes and several pathological conditions, with superiority over other techniques. Other PoCUS applications have shown to effectively complement the LUS ultrasound assessment of the mechanically ventilated patient. SUMMARY Bedside techniques - such as EIT and PoCUS - are becoming standards of the care for mechanically ventilated patients to monitor the changes in lung aeration, ventilation and perfusion in response to treatment and to assess weaning from mechanical ventilation.
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L'Her E, Nazir S, Pateau V, Visvikis D. Accuracy of noncontact surface imaging for tidal volume and respiratory rate measurements in the ICU. J Clin Monit Comput 2021; 36:775-783. [PMID: 33886075 PMCID: PMC8060689 DOI: 10.1007/s10877-021-00708-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/13/2021] [Indexed: 01/24/2023]
Abstract
Tidal volume monitoring may help minimize lung injury during respiratory assistance. Surface imaging using time-of-flight camera is a new, non-invasive, non-contact, radiation-free, and easy-to-use technique that enables tidal volume and respiratory rate measurements. The objectives of the study were to determine the accuracy of Time-of-Flight volume (VTTOF) and respiratory rate (RRTOF) measurements at the bedside, and to validate its application for spontaneously breathing patients under high flow nasal canula. Data analysis was performed within the ReaSTOC data-warehousing project (ClinicalTrials.gov identifier NCT02893462). All data were recorded using standard monitoring devices, and the computerized medical file. Time-of-flight technique used a Kinect V2 (Microsoft, Redmond, WA, USA) to acquire the distance information, based on measuring the phase delay between the emitted light-wave and received backscattered signals. 44 patients (32 under mechanical ventilation; 12 under high-flow nasal canula) were recorded. High correlation (r = 0.84; p < 0.001), with low bias (-1.7 mL) and acceptable deviation (75 mL) was observed between VTTOF and VTREF under ventilation. Similar performance was observed for respiratory rate (r = 0.91; p < 0.001; bias < 1b/min; deviation ≤ 5b/min). Measurements were possible for all patients under high-flow nasal canula, detecting overdistension in 4 patients (tidal volume > 8 mL/kg) and low ventilation in 6 patients (tidal volume < 6 mL/kg). Tidal volume monitoring using time-of-flight camera (VTTOF) is correlated to reference values. Time-of-flight camera enables continuous and non-contact respiratory monitoring under high-flow nasal canula, and enables to detect tidal volume and respiratory rate changes, while modifying flow. It enables respiratory monitoring for spontaneously patients, especially while using high-flow nasal oxygenation.
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Affiliation(s)
- Erwan L'Her
- Médecine Intensive Et Réanimation, CHRU de La Cavale Blanche, Bvd. Tanguy-Prigent, 29609, BREST Cedex, France. .,LATIM INSERM UMR 1101, Université de Bretagne Occidentale, BREST, France.
| | - Souha Nazir
- LATIM INSERM UMR 1101, Université de Bretagne Occidentale, BREST, France
| | - Victoire Pateau
- Médecine Intensive Et Réanimation, CHRU de La Cavale Blanche, Bvd. Tanguy-Prigent, 29609, BREST Cedex, France
| | - Dimitris Visvikis
- LATIM INSERM UMR 1101, Université de Bretagne Occidentale, BREST, France
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256
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See W, Morin C, Sage M, Stowe S, Gohier C, Nault S, Micheau P, Adler A, Fortin-Pellerin É. Air distribution within the lungs after total liquid ventilation in a neonatal ovine model. Respir Physiol Neurobiol 2021; 290:103666. [PMID: 33798788 DOI: 10.1016/j.resp.2021.103666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To gain insight into the total and regional lung aeration dynamics at the transition from total liquid ventilation (TLV) to conventional mechanical ventilation (GV). METHODS Neonatal lambs received either TLV for 4 h followed by GV (n = 15) or GV only (n = 11, controls). Monitoring was performed in the prone position with both videofluoroscopy and electrical impedance tomography (EIT) for the first 10 min of the transition. RESULTS Total and regional end-expiratory lung volumes were stable throughout the transition (p < 0.05). The percentage of tidal volume, liquid and/or gaseous, distributed to the different regions was stable (p < 0.05). Radiopacity of the nondependent regions markedly decreased at end-expiration (p < 0.01), reflecting the progressive transition to a gaseous end-expiratory lung volume. CONCLUSION Weaning to GV did not increase total or regional lung volumes, suggesting that the risk of overdistention was not increased. Residual perfluorocarbon in the dependent lung regions might account for the high O2 needs we observed in the first minutes of GV after TLV.
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Affiliation(s)
- Wendy See
- Department of Pharmacology-Physiology, Université de Sherbrooke, 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
| | - Christophe Morin
- Department of Pharmacology-Physiology, Université de Sherbrooke, 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
| | - Michaël Sage
- Department of Pharmacology-Physiology, Université de Sherbrooke, 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
| | - Symon Stowe
- Department of Computer Engineering, Carleton University, 1125 Colonel By Dr, Ottawa, K1S 5B6, ON, Canada.
| | - Catherine Gohier
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke. 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
| | - Stéphanie Nault
- Department of Pharmacology-Physiology, Université de Sherbrooke, 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
| | - Philippe Micheau
- Department of Mechanical Engineering, Université de Sherbrooke. 2500 Boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada.
| | - Andy Adler
- Department of Computer Engineering, Carleton University, 1125 Colonel By Dr, Ottawa, K1S 5B6, ON, Canada.
| | - Étienne Fortin-Pellerin
- Department of Pharmacology-Physiology, Université de Sherbrooke, 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada; Department of Pediatrics, Université de Sherbrooke. 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
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257
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Zheng E, Wan J, Yang L, Wang Q, Qiao H. Wrist Angle Estimation With a Musculoskeletal Model Driven by Electrical Impedance Tomography Signals. IEEE Robot Autom Lett 2021. [DOI: 10.1109/lra.2021.3060400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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258
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Yang L, Dai M, Möller K, Frerichs I, Adler A, Fu F, Zhao Z. Lung regions identified with CT improve the value of global inhomogeneity index measured with electrical impedance tomography. Quant Imaging Med Surg 2021; 11:1209-1219. [PMID: 33816161 DOI: 10.21037/qims-20-682] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The global inhomogeneity (GI) index is a functional electrical impedance tomography (EIT) parameter which is used clinically to assess ventilation distribution. However, GI may underestimate the actual heterogeneity when the size of lung regions is underestimated. We propose a novel method to use anatomical information to correct the GI index calculation. Methods EIT measurements were performed at the level of the fifth intercostal space in six patients with acute respiratory distress syndrome. The thorax and lungs were segmented automatically from serial individual CT scans. The anatomically derived lung regions were calculated in EIT images from simulating a homogeneous ventilation distribution in a finite element model. The conventional approach (GImeas,func ), analyzes images in functionally-defined lung regions, while our proposed measure (GImeas,anat ) is based on analysis in anatomically-defined regions. We additionally define a simulated comparison (GIsim,anat ) to determine the lower limit of the GI measure for a homogenous distribution of ventilation. Results As expected, the conventional GImeas,func [0.382 (0.088), median (interquartile range)] were significantly lower than the proposed GImeas,anat [0.823 (0.152), P<0.05], and were much closer to the lower limit GIsim,anat [0.343 (0.039)]. Both GImeas,anat and GImeas,func were strongly correlated with arterial oxygen partial pressure to fractional inspired oxygen ratio (R=-0.88, P<0.05), whereas GIsim,anat (R=0.23) was not. GImeas,anat had a linear-regression slope 3.2 times that of GImeas,func suggesting a higher sensitivity to the changes in lung condition. Conclusions The proposed GImeas,anat (or shortened as GIanat ) is an improved measure of ventilation inhomogeneity over GI, and better reflects portion of non-ventilated regions due to alveolar collapse or overdistension.
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Affiliation(s)
- Lin Yang
- Department of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Meng Dai
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Knut Möller
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre of Schleswig-Holstein Campus Kiel, Germany
| | - Andy Adler
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Canada
| | - Feng Fu
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.,Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
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Cutuli SL, Grieco DL, Menga LS, De Pascale G, Antonelli M. Noninvasive ventilation and high-flow oxygen therapy for severe community-acquired pneumonia. Curr Opin Infect Dis 2021; 34:142-150. [PMID: 33470666 PMCID: PMC9698117 DOI: 10.1097/qco.0000000000000715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We review the evidence on the use of noninvasive respiratory supports (noninvasive ventilation and high-flow nasal cannula oxygen therapy) in patients with acute respiratory failure because of severe community-acquired pneumonia. RECENT FINDINGS Noninvasive ventilation is strongly advised for the treatment of hypercapnic respiratory failure and recent evidence justifies its use in patients with hypoxemic respiratory failure when delivered by helmet. Indeed, such interface allows alveolar recruitment by providing high level of positive end-expiratory pressure, which improves hypoxemia. On the other hand, high-flow nasal cannula oxygen therapy is effective in patients with hypoxemic respiratory failure and some articles support its use in patients with hypercapnia. However, early identification of noninvasive respiratory supports treatment failure is crucial to prevent delayed orotracheal intubation and protective invasive mechanical ventilation. SUMMARY Noninvasive ventilation is the first-line therapy in patients with acute hypercapnic respiratory failure because of pneumonia. Although an increasing amount of evidence investigated the application of noninvasive respiratory support to hypoxemic respiratory failure, the optimal ventilatory strategy in this setting is uncertain. Noninvasive mechanical ventilation delivered by helmet and high-flow nasal cannula oxygen therapy appear as promising tools but their role needs to be confirmed by future research.
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Affiliation(s)
- Salvatore Lucio Cutuli
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - Domenico Luca Grieco
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - Luca Salvatore Menga
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - Gennaro De Pascale
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - Massimo Antonelli
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
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Tidal volume and stroke volume changes caused by respiratory events during sleep and their relationship with OSA severity: a pilot study. Sleep Breath 2021; 25:2025-2038. [PMID: 33683548 DOI: 10.1007/s11325-021-02334-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Breath-by-breath tidal volume (TV) and beat-by-beat stroke volume (SV) were continuously measured in patients with OSA undergoing polysomnography (PSG). The objectives were to (1) determine the changes in TV/SV in response to respiratory events and (2) assess the relationship between these changes and the disease severity. METHODS From the PSG data of nine patients with OSA, six different types of respiratory events were identified, i.e., flow limitation (FL), respiratory effort related arousal (RERA), hypopnea with arousal only (Ha), hypopnea with desaturation only (Hd), hypopnea with arousal and desaturation (Had), and apnea. The measured TV and SV values during and after each respiratory event were compared with the pre-event baseline values. RESULTS The mean TV/SV reductions during all hypopneas and apneas were 38.1%/4.2% and 70.5%/8.8%, respectively. Among three different hypopnea types, the reductions in TV during Hd and Had were significantly greater than those during Ha. The TV reductions during Ha and FL were similar. After RERA, Ha, Had, and apnea, there was an overshoot in TV and SV values, whereas there was no overshoot after FL and Hd. During RERA, there was no reduction in TV/SV. CONCLUSIONS The changes in TV during and after each type of respiratory event were significantly different in most cases. The changes in SV between hypopnea and apnea were different with statistical significance. The AHI does not properly account for the ventilation losses caused by respiratory events. Thus, TV measurements might be useful in the future in assessing the OSA severity in conjunction with the AHI.
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261
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Assessment of Electrical Impedance Tomography to Set Optimal Positive End-Expiratory Pressure for Venoarterial Extracorporeal Membrane Oxygenation-Treated Patients. Crit Care Med 2021; 49:923-933. [PMID: 33595959 DOI: 10.1097/ccm.0000000000004892] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patients on venoarterial extracorporeal membrane oxygenation have many risk factors for pulmonary complications in addition to their heart failure. Optimal positive end-expiratory pressure is unknown in these patients. The aim was to evaluate the ability of electrical impedance tomography to help the physician to select the optimal positive end-expiratory pressure in venoarterial extracorporeal membrane oxygenation treated and mechanically ventilated patients during a positive end-expiratory pressure trial. DESIGN Observational prospective monocentric. SETTING University hospital. PATIENTS Patients (n = 23) older than 18 years old, on mechanical ventilation and venoarterial extracorporeal membrane oxygenation. INTERVENTIONS A decreasing positive end-expiratory pressure trial (20-5 cm H2O) in increments of 5 cm H2O was performed and monitored by a collection of clinical parameters, ventilatory and ultrasonographic (cardiac and pulmonary) to define an optimal positive end-expiratory pressure according to respiratory criteria (optimal positive end-expiratory pressure selected by physician with respiratory parameters), and then adjusted according to hemodynamic and cardiac tolerances (optimal positive end-expiratory pressure selected by physician with respiratory, hemodynamic, and echocardiographic parameters). At the same time, electrical impedance tomography data (regional distribution of ventilation, compliance, and overdistension collapse) were recorded and analyzed retrospectively to define the optimal positive end-expiratory pressure. MEASUREMENTS AND MAIN RESULTS The median of this optimal positive end-expiratory pressure was 10 cm H2O in our population. Electrical impedance tomography showed that increasing positive end-expiratory pressure promoted overdistention of ventral lung, maximum at positive end-expiratory pressure 20 cm H20 (34% [interquartile range, 24.5-40]). Decreasing positive end-expiratory pressure resulted in collapse of dorsal lung (29% [interquartile range, 21-45.8]). The optimal positive end-expiratory pressure selected by physician with respiratory parameters was not different from the positive end-expiratory pressure chosen by the electrical impedance tomography. However, there is a negative impact of a high level of intrathoracic pressure on hemodynamic and cardiac tolerances. CONCLUSIONS Our results support that electrical impedance tomography appears predictive to define optimal positive end-expiratory pressure on venoarterial extracorporeal membrane oxygenation, aided by echocardiography to optimize hemodynamic assessment and management.
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262
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Lasarow L, Vogt B, Zhao Z, Balke L, Weiler N, Frerichs I. Regional lung function measures determined by electrical impedance tomography during repetitive ventilation manoeuvres in patients with COPD. Physiol Meas 2021; 42:015008. [PMID: 33434902 DOI: 10.1088/1361-6579/abdad6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Current standards for conducting spirometry examinations recommend that the ventilation manoeuvres needed in pulmonary function testing are carried out repeatedly during sessions. Chest electrical impedance tomography (EIT) can determine the presence of ventilation heterogeneity during such manoeuvres, which increases the information content derived from such examinations. The aim of this study was to characterise regional lung function in patients with chronic obstructive pulmonary disease (COPD) during repetitive forced full ventilation manoeuvres. Regional lung function measures derived from these manoeuvres were compared with quiet tidal breathing. APPROACH Sixty hospitalised patients were examined during up to three repeated ventilation manoeuvres. Acceptable spirometry manoeuvres were performed and EIT recordings suitable for analysis obtained in 53 patients (12 women, 41 men; age: 68 ± 12 years (mean ± SD)). Pixel values of tidal volume, forced full inspiratory and expiratory volume in 1 s, and forced inspiratory and expiratory vital capacity were calculated from the EIT data. Spatial ventilation heterogeneity was assessed using the coefficient of variation, global inhomogeneity index, and centres and regional fractions of ventilation. Temporal inhomogeneity was determined by examining the pixel expiration times needed to exhale 50% and 75% of regional forced vital capacity. MAIN RESULTS All EIT-derived measures of regional lung function showed reproducible results during repetitive examinations. Parameters of spatial heterogeneity obtained from quiet tidal breathing were comparable with the measures derived from the forced manoeuvres. SIGNIFICANCE Measures of spatial and temporal ventilation heterogeneity obtained in COPD patients by EIT provide comparable findings during repeated examinations within one testing session. Quiet tidal breathing generates similar information on ventilation heterogeneity as forced manoeuvres that demand a high amount of patient effort.
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Affiliation(s)
- L Lasarow
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - B Vogt
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Z Zhao
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany.,Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, People's Republic of China
| | - L Balke
- Department of Pneumology, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - N Weiler
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - I Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
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263
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Hsu HJ, Chang HT, Zhao Z, Wang PH, Zhang JH, Chen YS, Frerichs I, Möller K, Fu F, Hsu HS, Chuang SP, Hsia HY, Yen DHT. Positive end-expiratory pressure titration with electrical impedance tomography and pressure-volume curve: a randomized trial in moderate to severe ARDS. Physiol Meas 2021; 42:014002. [PMID: 33361553 DOI: 10.1088/1361-6579/abd679] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of the study was to compare titration of positive end-expiratory pressure (PEEP) with electrical impedance tomography (EIT) and with ventilator-embedded pressure-volume (PV) loop in moderate to severe acute respiratory distress syndrome (ARDS). APPROACH Eighty-seven moderate to severe ARDS patients (arterial oxygen partial pressure to fractional inspired oxygen ratio, PaO2/FiO2 ≤ 200 mmHg) were randomized to either EIT group (n = 42) or PV group (n = 45). All patients received identical medical care using the same general support guidelines and protective mechanical ventilation. In the EIT group, the selected PEEP equaled the airway pressure at the intercept between cumulated collapse and overdistension percentages curves and in the PV group, at the pressure where maximal hysteresis was reached. MAIN RESULTS Baseline characteristics and settings were comparable between the groups. After optimization, PEEP was significantly higher in the PV group (17.4 ± 1.7 versus 16.2 ± 2.6 cmH2O, PV versus EIT groups, p = 0.02). After 48 h, driving pressure was significantly higher in the PV group (12.4 ± 3.6 versus 10.9 ± 2.5 cmH2O, p = 0.04). Lung mechanics and oxygenation were better in the EIT group but did not statistically differ between the groups. The survival rate was lower in the PV group (44.4% versus 69.0%, p = 0.02; hazard ratio 2.1, confidence interval 1·1-3.9). None of the other pre-specified exploratory clinical endpoints were significantly different. SIGNIFICANCE In moderate to severe ARDS, PEEP titration guided with EIT, compared with PV curve, might be associated with improved driving pressure and survival rate. TRIAL REGISTRATION NCT03112512, 13 April, 2017.
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Affiliation(s)
- Hui-Ju Hsu
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan. Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
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264
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Tingay DG, Farrell O, Thomson J, Perkins EJ, Pereira-Fantini PM, Waldmann AD, Rüegger C, Adler A, Davis PG, Frerichs I. Imaging the Respiratory Transition at Birth: Unraveling the Complexities of the First Breaths of Life. Am J Respir Crit Care Med 2021; 204:82-91. [PMID: 33545023 DOI: 10.1164/rccm.202007-2997oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: The transition to air breathing at birth is a seminal respiratory event common to all humans, but the intrathoracic processes remain poorly understood. Objectives: The objectives of this prospective, observational study were to describe the spatiotemporal gas flow, aeration, and ventilation patterns within the lung in term neonates undergoing successful respiratory transition. Methods: Electrical impedance tomography was used to image intrathoracic volume patterns for every breath until 6 minutes from birth in neonates born by elective cesearean section and not needing resuscitation. Breaths were classified by video data, and measures of lung aeration, tidal flow conditions, and intrathoracic volume distribution calculated for each inflation. Measurements and Main Results: A total of 1,401 breaths from 17 neonates met all eligibility and data analysis criteria. Stable FRC was obtained by median (interquartile range) 43 (21-77) breaths. Breathing patterns changed from predominantly crying (80.9% first min) to tidal breathing (65.3% sixth min). From birth, tidal ventilation was not uniform within the lung, favoring the right and nondependent regions; P < 0.001 versus left and dependent regions (mixed-effects model). Initial crying created a unique volumetric pattern with delayed midexpiratory gas flow associated with intrathoracic volume redistribution (pendelluft flow) within the lung. This preserved FRC, especially within the dorsal and right regions. Conclusions: The commencement of air breathing at birth generates unique flow and volume states associated with marked spatiotemporal ventilation inhomogeneity not seen elsewhere in respiratory physiology. At birth, neonates innately brake expiratory flow to defend FRC gains and redistribute gas to less aerated regions.
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Affiliation(s)
- David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Neonatology, Royal Children's Hospital, Melbourne, Australia.,Neonatal Research, The Royal Women's Hospital, Melbourne, Australia
| | - Olivia Farrell
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jessica Thomson
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Prue M Pereira-Fantini
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Andreas D Waldmann
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Germany
| | | | - Andy Adler
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada; and
| | - Peter G Davis
- Neonatal Research, The Royal Women's Hospital, Melbourne, Australia
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
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265
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Cornejo R, Iturrieta P, Olegário TMM, Kajiyama C, Arellano D, Guiñez D, Cerda MA, Brito R, Gajardo AIJ, Lazo M, López L, Morais CCA, González S, Zavala M, Rojas V, Medel JN, Hurtado DE, Bruhn A, Ramos C, Estuardo N. Estimation of changes in cyclic lung strain by electrical impedance tomography: Proof-of-concept study. Acta Anaesthesiol Scand 2021; 65:228-235. [PMID: 33037607 DOI: 10.1111/aas.13723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023]
Abstract
RATIONALE Cyclic strain may be a determinant of ventilator-induced lung injury. The standard for strain assessment is the computed tomography (CT), which does not allow continuous monitoring and exposes to radiation. Electrical impedance tomography (EIT) is able to monitor changes in regional lung ventilation. In addition, there is a correlation between mechanical deformation of materials and detectable changes in its electrical impedance, making EIT a potential surrogate for cyclic lung strain measured by CT (StrainCT ). OBJECTIVES To compare the global StrainCT with the change in electrical impedance (ΔZ). METHODS Acute respiratory distress syndrome patients under mechanical ventilation (VT 6 mL/kg ideal body weight with positive end-expiratory pressure 5 [PEEP 5] and best PEEP according to EIT) underwent whole-lung CT at end-inspiration and end-expiration. Biomechanical analysis was used to construct 3D maps and determine StrainCT at different levels of PEEP. CT and EIT acquisitions were performed simultaneously. Multilevel analysis was employed to determine the causal association between StrainCT and ΔZ. Linear regression models were used to predict the change in lung StrainCT between different PEEP levels based on the change in ΔZ. MAIN RESULTS StrainCT was positively and independently associated with ΔZ at global level (P < .01). Furthermore, the change in StrainCT (between PEEP 5 and Best PEEP) was accurately predicted by the change in ΔZ (R2 0.855, P < .001 at global level) with a high agreement between predicted and measured StrainCT . CONCLUSIONS The change in electrical impedance may provide a noninvasive assessment of global cyclic strain, without radiation at bedside.
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Affiliation(s)
- Rodrigo Cornejo
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
- Center of Acute Respiratory Critical Illness (ARCI) Santiago Chile
| | - Pablo Iturrieta
- Department of Structural and Geotechnical Engineering School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | | | | | - Daniel Arellano
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
- Departamento de kinesiología Facultad de Medicina Universidad de Chile Santiago Chile
| | - Dannette Guiñez
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - María A. Cerda
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Roberto Brito
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Abraham I. J. Gajardo
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Marioli Lazo
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Lorena López
- Departamento de Radiología Hospital Clínico Universidad de Chile Santiago Chile
| | - Caio C. A. Morais
- Divisao de Pneumologia Faculdade de Medicina Instituto do Coracao Hospital das Clinicas HCFMUSP Universidade de Sao Paulo Sao Paulo Brazil
| | - Sedric González
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Miguel Zavala
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Verónica Rojas
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Juan N. Medel
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Daniel E. Hurtado
- Department of Structural and Geotechnical Engineering School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
- Institute for Biological and Medical Engineering School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | - Alejandro Bruhn
- Center of Acute Respiratory Critical Illness (ARCI) Santiago Chile
- Departamento de Medicina Intensiva Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Cristobal Ramos
- Departamento de Radiología Hospital Clínico Universidad de Chile Santiago Chile
| | - Nivia Estuardo
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
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266
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De Luca D. Respiratory distress syndrome in preterm neonates in the era of precision medicine: A modern critical care-based approach. Pediatr Neonatol 2021; 62 Suppl 1:S3-S9. [PMID: 33358440 DOI: 10.1016/j.pedneo.2020.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023] Open
Abstract
Respiratory distress syndrome (RDS) was recognized to be caused by primary surfactant deficiency almost 70 years ago and continuous positive airway pressure was introduced approximately 50 years ago. Since then, there have been many developments in neonatology; we know many things but others are still controversial. The more we know, the more questions arise. However, this review aims to indicate what is more needed to understand and how should be the modern approach to RDS in the era of precision medicine. The review is divided between new concepts and new tools. We will explain the interaction between steroids, CPAP and surfactant, as well as the surfactant catabolism and the diagnosis of NARDS; lung ultrasound and new tools to optimize CPAP will also be covered. How these concepts are integrated in the author's personal experience is also illustrated.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France.
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267
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Sang L, Zheng X, Zhao Z, Zhong M, Jiang L, Huang Y, Liu X, Li Y, Zhang D. Lung Recruitment, Individualized PEEP, and Prone Position Ventilation for COVID-19-Associated Severe ARDS: A Single Center Observational Study. Front Med (Lausanne) 2021; 7:603943. [PMID: 33553203 PMCID: PMC7862746 DOI: 10.3389/fmed.2020.603943] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/17/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Patients with coronavirus disease 2019 (COVID-19) may develop severe acute respiratory distress syndrome (ARDS). The aim of the study was to explore the lung recruitability, individualized positive end-expiratory pressure (PEEP), and prone position in COVID-19-associated severe ARDS. Methods: Twenty patients who met the inclusion criteria were studied retrospectively (PaO2/FiO2 68.0 ± 10.3 mmHg). The patients were ventilated under volume-controlled mode with tidal volume of 6 mL/kg predicted body weight. The lung recruitability was assessed via the improvement of PaO2, PaCO2, and static respiratory system compliance (Cstat) from low to high PEEP (5-15 cmH2O). Patients were considered recruitable if two out of three parameters improved. Subsequently, PEEP was titrated according to the best Cstat. The patients were turned to prone position for further 18-20 h. Results: For recruitability assessment, average value of PaO2 was slightly improved at PEEP 15 cmH2O (68.0 ± 10.3 vs. 69.7 ± 7.9 mmHg, baseline vs. PEEP 15 cmH2O; p = 0.31). However, both PaCO2 and Cstat worsened (PaCO2: 72.5 ± 7.1 vs. 75.1 ± 9.0 mmHg; p < 0.01. Cstat: 17.5 ± 3.5 vs. 16.6 ± 3.9 ml/cmH2O; p = 0.05). Only four patients (20%) were considered lung recruitable. Individually titrated PEEP was higher than the baseline PEEP (8.0 ± 2.1 cmH2O vs. 5 cmH2O, p < 0.001). After 18-20 h of prone positioning, investigated parameters were significantly improved compared to the baseline (PaO2: 82.4 ± 15.5 mmHg. PaCO2: 67.2 ± 6.4 mmHg. Cstat: 20.6 ± 4.4 ml/cmH2O. All p < 0.001 vs. baseline). Conclusions: Lung recruitability was very low in COVID-19-associated severe ARDS. Individually titrated PEEP and prone positioning might improve lung mechanics and blood gasses.
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Affiliation(s)
- Ling Sang
- State Key Lab of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.,Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Min Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongbo Huang
- State Key Lab of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- State Key Lab of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- State Key Lab of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dingyu Zhang
- Research Center for Translational Medicine, Wuhan Jinyintan Hospital, Wuhan, China.,Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, China
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268
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Evaluation of Regional Pulmonary Ventilation in Spontaneously Breathing Patients with Idiopathic Pulmonary Fibrosis (IPF) Employing Electrical Impedance Tomography (EIT): A Pilot Study from the European IPF Registry (eurIPFreg). J Clin Med 2021; 10:jcm10020192. [PMID: 33430489 PMCID: PMC7827956 DOI: 10.3390/jcm10020192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/14/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives: In idiopathic pulmonary fibrosis (IPF), alterations in the pulmonary surfactant system result in an increased alveolar surface tension and favor repetitive alveolar collapse. This study aimed to assess the usefulness of electrical impedance tomography (EIT) in characterization of regional ventilation in IPF. Materials and methods: We investigated 17 patients with IPF and 15 healthy controls from the University of Giessen and Marburg Lung Center (UGMLC), Germany, for differences in the following EIT parameters: distribution of ventilation (TID), global inhomogeneity index (GI), regional impedance differences through the delta of end-expiratory lung impedance (dEELI), differences in surface of ventilated area (SURF), as well as center of ventilation (CG) and intratidal gas distribution (ITV). These parameters were assessed under spontaneous breathing and following a predefined escalation protocol of the positive end-expiratory pressure (PEEP), applied through a face mask by an intensive care respirator (EVITA, Draeger, Germany). Results: Individual slopes of dEELI over the PEEP increment protocol were found to be highly significantly increased in both groups (p < 0.001) but were not found to be significantly different between groups. Similarly, dTID slopes were increasing in response to PEEP, but this did not reach statistical significance within or between groups. Individual breathing patterns were very heterogeneous. There were no relevant differences of SURF, GI or CGVD over the PEEP escalation range. A correlation of dEELI to FVC, BMI, age, or weight did not forward significant results. Conclusions: In this study, we did see a significant increase in dEELI and a non-significant increase in dTID in IPF patients as well as in healthy controls in response to an increase of PEEP under spontaneous breathing. We propose the combined measurements of EIT and lung function to assess regional lung ventilation in spontaneously breathing subjects.
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269
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Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications. Pediatr Res 2021; 90:524-531. [PMID: 30127522 PMCID: PMC7094915 DOI: 10.1038/s41390-018-0114-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/28/2018] [Accepted: 06/20/2018] [Indexed: 01/29/2023]
Abstract
Lung ultrasound (LUS) is the latest amongst imaging techniques: it is a radiation-free, inexpensive, point-of-care tool that the clinician can use at the bedside. This review summarises the rapidly growing scientific evidence on LUS in neonatology, dividing it into descriptive and functional applications. We report the description of the main ultrasound features of neonatal respiratory disorders and functional applications of LUS aiming to help a clinical decision (such as surfactant administration, chest drainage etc). Amongst the functional applications, we propose SAFE (Sonographic Algorithm for liFe threatening Emergencies) as a standardised protocol for emergency functional LUS in critical neonates. SAFE has been funded by a specific grant issued by the European Society for Paediatric Research. Future potential development of LUS in neonatology might be linked to its quantitative evaluation: we also discuss available data and research directions using computer-aided diagnostic techniques. Finally, tools and opportunities to teach LUS and expand the research network are briefly presented.
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270
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Schinckel NF, Hickey L, Perkins EJ, Pereira-Fantini PM, Koeppenkastrop S, Stafford I, Dowse G, Tingay DG. Skin-to-skin care alters regional ventilation in stable neonates. Arch Dis Child Fetal Neonatal Ed 2021; 106:76-80. [PMID: 32732379 DOI: 10.1136/archdischild-2020-319136] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Skin-to-skin care (SSC) has proven psychological benefits; however, the physiological effects are less clearly defined. Regional ventilation patterns during SSC have not previously been reported. This study aimed to compare regional ventilation indices and other cardiorespiratory parameters during prone SSC with supine and prone position cot-nursing. DESIGN Prospective observational study. SETTING Single quaternary neonatal intensive care unit in Australia. PATIENTS 20 infants spontaneously breathing (n=17) or on non-invasive ventilation (n=3), with mean (SD) gestational age at birth of 33 (5) weeks. INTERVENTIONS Thirty-minute episodes of care in each position: supine cot care, prone SSC and prone cot care preceding a 10 min period of continuous electrical impedance tomography measurements of regional ventilation. MAIN OUTCOME MEASURES In each position, ventral-dorsal and right-left centre of ventilation (CoV), percentage of whole lung ventilation by region and percentage of apparent unventilated lung regions were determined. Heart and respiratory rates, oxygen saturation and axillary temperature were also measured. RESULTS Heart and respiratory rates, oxygen saturation, temperature and right-left lung ventilation did not differ between the three positions (mixed-effects model). Ventilation generally favoured the dorsal lung, but the mean (95% CI) ventrodorsal CoV was -2.0 (-0.4 to -3.6)% more dorsal during SSC compared with prone. Supine position resulted in 5.0 (1.5 to 5.3)% and 4.5 (3.9 to 5.1)% less apparently unventilated lung regions compared with SSC and prone, respectively. CONCLUSIONS In clinically stable infants, SSC generates a distinct regional ventilation pattern that is independent of prone position and results in greater distribution of ventilation towards the dorsal lung.
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Affiliation(s)
- Nicholas F Schinckel
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia .,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leah Hickey
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Prue M Pereira-Fantini
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sienna Koeppenkastrop
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Isabella Stafford
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Georgie Dowse
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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271
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Synchronized Inflations Generate Greater Gravity-Dependent Lung Ventilation in Neonates. J Pediatr 2021; 228:24-30.e10. [PMID: 32827530 DOI: 10.1016/j.jpeds.2020.08.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/05/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe the regional distribution patterns of tidal ventilation within the lung during mechanical ventilation that is synchronous or asynchronous with an infant's own breathing effort. STUDY DESIGN Intubated infants receiving synchronized mechanical ventilation at The Royal Children's Hospital neonatal intensive care unit were studied. During four 10-minute periods of routine care, regional distribution of tidal volume (VT; electrical impedance tomography), delivered pressure, and airway flow (Florian Respiratory Monitor) were measured for every inflation. Post hoc, each inflation was then classified as synchronous or asynchronous from video data of the ventilator screen, and the distribution of absolute VT and delivered ventilation characteristics determined. RESULTS In total, 2749 inflations (2462 synchronous) were analyzed in 19 infants; mean (SD) age 28 (30) days, gestational age 35 (5) weeks. Synchronous inflations were associated with a shorter respiratory cycle (P = .004) and more homogenous VT (center of ventilation) along the right (0%) to left (100%) lung plane; 45.3 (8.6)% vs 48.8 (9.4)% (uniform ventilation 46%). The gravity-dependent center of ventilation was a mean (95% CI) 2.1 (-0.5, 4.6)% toward the dependent lung during synchronous inflations. Tidal ventilation relative to anatomical lung size was more homogenous during synchronized inflations in the dependent lung. CONCLUSIONS Synchronous mechanical ventilator lung inflations generate more gravity-dependent lung ventilation and more uniform right-to-left ventilation than asynchronous inflations.
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272
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Bayford R, Bertemes-Filho P, Frerichs I. Topical issues in electrical impedance tomography and bioimpedance application research. Physiol Meas 2020; 41:120301. [PMID: 33432931 DOI: 10.1088/1361-6579/abcb5b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Richard Bayford
- Department of Natural Science, Middlesex University, London, UK
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273
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A General Grid-Less Design Method for Location and Pressure Sensors with High Precision. SENSORS 2020; 20:s20247286. [PMID: 33353030 PMCID: PMC7766643 DOI: 10.3390/s20247286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/03/2022]
Abstract
Bionic electronic skin can accurately sense and locate surface pressure, which is widely demanded in many fields. Traditional electronic skin design usually relies on grid-architecture sensor arrays, requiring complex grid and interconnection arrangements as well as high cost. Grid-less planar sensors can solve the problem by using electrodes only at the edges, but they usually require the use of mapping software such as electrical impedance tomography to achieve high precision. In this work, a design method of high-precision grid-less planar pressure sensors based on the back-propagation (BP) neural network is proposed. The measurement precision of this method is demonstrated to be over two orders of magnitude higher than that of a grid-structure sensor array with the same electrode distribution density. Moreover, this method can be used for irregularly-shaped and non-uniform sensors, which further reduces the manufacturing difficulty and increases the application flexibility.
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274
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Proença M, Braun F, Lemay M, Solà J, Adler A, Riedel T, Messerli FH, Thiran JP, Rimoldi SF, Rexhaj E. Non-invasive pulmonary artery pressure estimation by electrical impedance tomography in a controlled hypoxemia study in healthy subjects. Sci Rep 2020; 10:21462. [PMID: 33293566 PMCID: PMC7722929 DOI: 10.1038/s41598-020-78535-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/25/2020] [Indexed: 11/09/2022] Open
Abstract
Pulmonary hypertension is a hemodynamic disorder defined by an abnormal elevation of pulmonary artery pressure (PAP). Current options for measuring PAP are limited in clinical practice. The aim of this study was to evaluate if electrical impedance tomography (EIT), a radiation-free and non-invasive monitoring technique, can be used for the continuous, unsupervised and safe monitoring of PAP. In 30 healthy volunteers we induced gradual increases in systolic PAP (SPAP) by exposure to normobaric hypoxemia. At various stages of the protocol, the SPAP of the subjects was estimated by transthoracic echocardiography. In parallel, in the pulmonary vasculature, pulse wave velocity was estimated by EIT and calibrated to pressure units. Within-cohort agreement between both methods on SPAP estimation was assessed through Bland-Altman analysis and at subject level, with Pearson's correlation coefficient. There was good agreement between the two methods (inter-method difference not significant (P > 0.05), bias ± standard deviation of - 0.1 ± 4.5 mmHg) independently of the degree of PAP, from baseline oxygen saturation levels to profound hypoxemia. At subject level, the median per-subject agreement was 0.7 ± 3.8 mmHg and Pearson's correlation coefficient 0.87 (P < 0.05). Our results demonstrate the feasibility of accurately assessing changes in SPAP by EIT in healthy volunteers. If confirmed in a patient population, the non-invasive and unsupervised day-to-day monitoring of SPAP could facilitate the clinical management of patients with pulmonary hypertension.
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Affiliation(s)
- Martin Proença
- Systems Division, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland. .,Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Fabian Braun
- Systems Division, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland.,Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Mathieu Lemay
- Systems Division, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland
| | - Josep Solà
- Systems Division, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland
| | - Andy Adler
- Systems and Computer Engineering, Carleton University, Ottawa, Canada
| | - Thomas Riedel
- Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland.,Department of Paediatrics, Inselspital Bern, University Children's Hospital, Bern, Switzerland
| | - Franz H Messerli
- Department of Cardiology and Clinical Research, Inselspital Bern, University Hospital, Bern, Switzerland
| | - Jean-Philippe Thiran
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Radiology, University Hospital Center (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Stefano F Rimoldi
- Department of Cardiology and Clinical Research, Inselspital Bern, University Hospital, Bern, Switzerland
| | - Emrush Rexhaj
- Department of Cardiology and Clinical Research, Inselspital Bern, University Hospital, Bern, Switzerland
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275
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Sang L, Zhao Z, Lin Z, Liu X, Zhong N, Li Y. A narrative review of electrical impedance tomography in lung diseases with flow limitation and hyperinflation: methodologies and applications. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1688. [PMID: 33490200 PMCID: PMC7812189 DOI: 10.21037/atm-20-4984] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Electrical impedance tomography (EIT) is a functional radiation-free imaging technique that measures regional lung ventilation distribution by calculating the impedance changes in the corresponding regions. The aim of the present review was to summarize the current literature concerning the methodologies and applications of EIT in lung diseases with flow limitation and hyperinflation. PubMed was searched up to May 2020 to identify studies investigating the use of EIT in patients with asthma, bronchiectasis, bronchitis, bronchiolitis, chronic obstructive pulmonary disease, and cystic fibrosis. The extracted data included study design, EIT methodologies, interventions, validation and comparators, population characteristics, and key findings. Of the 44 included studies, seven were related to simulation, animal experimentation, or reconstruction algorithm development with evaluation on patients; 27 studies had the primary objective of validating EIT technique and measures including regional ventilation distribution, regional EIT-spirometry parameters, end-expiratory lung impedance, and regional time constants; and 10 studies had the primary objective of applying EIT to monitor the response to therapeutic interventions, including various ventilation supports, patient repositioning, and airway suctioning. In pediatric and adult patients, EIT has been successfully validated for assessing spatial and temporal ventilation distribution, measuring changes in lung volume and flow, and studying regional respiratory mechanics. EIT has also demonstrated potential as an alternative or supplement to well-established measurement modalities (e.g., conventional pulmonary function testing) to monitor the progression of obstructive lung diseases, although the existing literature lacks prediction values as references and lacks clinical outcome evidence.
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Affiliation(s)
- Ling Sang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, the First Affiliated Hospital of Guangzhou Medical University, Department of Crit Care Med, Guangzhou, China
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.,Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Zhimin Lin
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, the First Affiliated Hospital of Guangzhou Medical University, Department of Crit Care Med, Guangzhou, China
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, the First Affiliated Hospital of Guangzhou Medical University, Department of Crit Care Med, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, the First Affiliated Hospital of Guangzhou Medical University, Department of Crit Care Med, Guangzhou, China
| | - Yimin Li
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, the First Affiliated Hospital of Guangzhou Medical University, Department of Crit Care Med, Guangzhou, China
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276
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He H, Chi Y, Long Y, Yuan S, Zhang R, Frerichs I, Möller K, Fu F, Zhao Z. Bedside Evaluation of Pulmonary Embolism by Saline Contrast Electrical Impedance Tomography Method: A Prospective Observational Study. Am J Respir Crit Care Med 2020; 202:1464-1468. [PMID: 32585116 PMCID: PMC7667910 DOI: 10.1164/rccm.202005-1780le] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Huaiwu He
- Peking Union Medical College Hospital Beijing, China
| | - Yi Chi
- Peking Union Medical College Hospital Beijing, China
| | - Yun Long
- Peking Union Medical College Hospital Beijing, China
| | - Siyi Yuan
- Peking Union Medical College Hospital Beijing, China
| | - Rui Zhang
- Peking Union Medical College Hospital Beijing, China
| | - Inéz Frerichs
- University Medical Center of Schleswig-Holstein Campus Kiel Kiel, Germany
| | - Knut Möller
- Furtwangen University Villingen-Schwenningen, Germany and
| | - Feng Fu
- Fourth Military Medical University Xi'an, China
| | - Zhanqi Zhao
- Furtwangen University Villingen-Schwenningen, Germany and.,Fourth Military Medical University Xi'an, China
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277
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Assessment of electrical impedance tomography to set optimal positive end-expiratory pressure for veno-venous ECMO-treated severe ARDS patients. J Crit Care 2020; 60:38-44. [DOI: 10.1016/j.jcrc.2020.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/07/2020] [Accepted: 06/28/2020] [Indexed: 11/22/2022]
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278
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He H, Long Y, Frerichs I, Zhao Z. Detection of Acute Pulmonary Embolism by Electrical Impedance Tomography and Saline Bolus Injection. Am J Respir Crit Care Med 2020; 202:881-882. [PMID: 32469613 DOI: 10.1164/rccm.202003-0554im] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Huaiwu He
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China; and.,Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
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279
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Nazir S, Pateau V, Bert J, Clement JF, Fayad H, l'Her E, Visvikis D. Surface imaging for real-time patient respiratory function assessment in intensive care. Med Phys 2020; 48:142-155. [PMID: 33118190 DOI: 10.1002/mp.14557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Monitoring of physiological parameters is a major concern in Intensive Care Units (ICU) given their role in the assessment of vital organ function. Within this context, one issue is the lack of efficient noncontact techniques for respiratory monitoring. In this paper, we present a novel noncontact solution for real-time respiratory monitoring and function assessment of ICU patients. METHODS The proposed system uses a Time-of-Flight depth sensor to analyze the patient's chest wall morphological changes in order to estimate multiple respiratory function parameters. The automatic detection of the patient's torso is also proposed using a deep neural network model trained on the COCO dataset. The evaluation of the proposed system was performed on a mannequin and on 16 mechanically ventilated patients (a total of 216 recordings) admitted in the ICU of the Brest University Hospital. RESULTS The estimation of respiratory parameters (respiratory rate and tidal volume) showed high correlation with the reference method (r = 0.99; P < 0.001 and r = 0.99; P < 0.001) in the mannequin recordings and (r = 0.95, P < 0.001 and r = 0.90, P < 0.001) for patients. CONCLUSION This study describes and evaluates a novel noncontact monitoring system suitable for continuous monitoring of key respiratory parameters for disease assessment of critically ill patients.
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Affiliation(s)
- Souha Nazir
- INSERM, UMR1101, LaTIM, University of Brest, Brest, 29200, France
| | | | - Julien Bert
- INSERM, UMR1101, LaTIM, University of Brest, Brest, 29200, France
| | | | - Hadi Fayad
- INSERM, UMR1101, LaTIM, University of Brest, Brest, 29200, France.,Hamad Medical Corporation OHS, PET/CT center Doha, Doha, Qatar
| | - Erwan l'Her
- INSERM, UMR1101, LaTIM, University of Brest, Brest, 29200, France.,CHRU, Brest, 29200, France
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280
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Shepherd EG, De Luca D. New Imaging Tools Allow Bronchopulmonary Dysplasia to Enter the Age of Precision Medicine. Am J Respir Crit Care Med 2020; 202:924-926. [PMID: 32551806 PMCID: PMC7528804 DOI: 10.1164/rccm.202005-2067ed] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Edward G Shepherd
- Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, Ohio
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Paris Saclay University Hospitals, Paris, France and.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris-Saclay University, Paris, France
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281
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Differential lung ventilation assessed by electrical impedance tomography in ultrasound-guided anterior suprascapular nerve block vs. interscalene brachial plexus block. Eur J Anaesthesiol 2020; 37:1105-1114. [DOI: 10.1097/eja.0000000000001367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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282
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Scaramuzzo G, Spinelli E, Spadaro S, Santini A, Tortolani D, Dalla Corte F, Pesenti A, Volta CA, Grasselli G, Mauri T. Gravitational distribution of regional opening and closing pressures, hysteresis and atelectrauma in ARDS evaluated by electrical impedance tomography. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:622. [PMID: 33092607 PMCID: PMC7579854 DOI: 10.1186/s13054-020-03335-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/06/2020] [Indexed: 01/26/2023]
Abstract
Background The physiological behavior of lungs affected by the acute respiratory distress syndrome (ARDS) differs between inspiration and expiration and presents heterogeneous gravity-dependent distribution. This phenomenon, highlighted by the different distribution of opening/closing pressure and by the hysteresis of the pressure–volume curve, can be studied by CT scan, but the technique expose the patient to radiations, cannot track changes during time and is not feasible at the bedside. Electrical impedance tomography (EIT) could help in assessing at the bedside regional inspiratory and expiratory mechanical properties. We evaluated regional opening/closing pressures, hysteresis and atelectrauma during inspiratory and expiratory low-flow pressure–volume curves in ARDS using electrical impedance tomography. Methods Pixel-level inspiratory and expiratory PV curves (PVpixel) between 5 and 40 cmH2O were constructed integrating EIT images and airway opening pressure signal from 8 ARDS patients. The lower inflection point in the inspiratory and expiratory PVpixel were used to find opening (OPpixel) and closing (CPpixel) pressures. A novel atelectrauma index (AtI) was calculated as the percentage of pixels opening during the inspiratory and closing during the expiratory PV curves. The maximal hysteresis (HysMax) was calculated as the maximal difference between normalized expiratory and inspiratory PV curves. Analyses were conducted in the global, dependent and non-dependent lung regions. Results Gaussian distribution was confirmed for both global OPpixel (r2 = 0.90) and global CPpixel (r2 = 0.94). The two distributions were significantly different with higher values for OPpixel (p < 0.0001). Regional OPpixel and CPpixel distributions were Gaussian, and in the dependent lung regions, both were significantly higher than in the non-dependent ones (p < 0.001). Both AtI and the HysMax were significantly higher in the dependent regions compared to the non-dependent ones (p < 0.05 for both). Conclusions Gravity impacts the regional distribution of opening and closing pressure, hysteresis and atelectrauma, with higher values in the dorsal lung. Regional differences between inspiratory and expiratory lung physiology are detectable at the bedside using EIT and could allow in-depth characterization of ARDS phenotypes and guide personalized ventilation settings. Graphic abstract ![]()
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Affiliation(s)
- Gaetano Scaramuzzo
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit, Azienda Ospedaliera Universitaria Sant'Anna Hospital, Ferrara, Italy
| | - Elena Spinelli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit, Azienda Ospedaliera Universitaria Sant'Anna Hospital, Ferrara, Italy
| | - Alessandro Santini
- Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Centre-IRCCS, Rozzano, Milan, Italy
| | - Donatella Tortolani
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit, Azienda Ospedaliera Universitaria Sant'Anna Hospital, Ferrara, Italy
| | - Francesca Dalla Corte
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit, Azienda Ospedaliera Universitaria Sant'Anna Hospital, Ferrara, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.,Department of Pathophysiology and Transplant, University of Milan, Milan, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit, Azienda Ospedaliera Universitaria Sant'Anna Hospital, Ferrara, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.,Department of Pathophysiology and Transplant, University of Milan, Milan, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy. .,Department of Pathophysiology and Transplant, University of Milan, Milan, Italy.
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283
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Mosing M, Waldmann AD, Sacks M, Buss P, Boesch JM, Zeiler GE, Hosgood G, Gleed RD, Miller M, Meyer LCR, Böhm SH. What hinders pulmonary gas exchange and changes distribution of ventilation in immobilized white rhinoceroses ( Ceratotherium simum) in lateral recumbency? J Appl Physiol (1985) 2020; 129:1140-1149. [PMID: 33054661 DOI: 10.1152/japplphysiol.00359.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This study used electrical impedance tomography (EIT) measurements of regional ventilation and perfusion to elucidate the reasons for severe gas exchange impairment reported in rhinoceroses during opioid-induced immobilization. EIT values were compared with standard monitoring parameters to establish a new monitoring tool for conservational immobilization and future treatment options. Six male white rhinoceroses were immobilized using etorphine, and EIT ventilation variables, venous admixture, and dead space were measured 30, 40, and 50 min after becoming recumbent in lateral position. Pulmonary perfusion mapping using impedance-enhanced EIT was performed at the end of the study period. The measured impedance (∆Z) by EIT was compared between pulmonary regions using mixed linear models. Measurements of regional ventilation and perfusion revealed a pronounced disproportional shift of ventilation and perfusion toward the nondependent lung. Overall, the dependent lung was minimally ventilated and perfused, but remained aerated with minimal detectable lung collapse. Perfusion was found primarily around the hilum of the nondependent lung and was minimal in the periphery of the nondependent and the entire dependent lung. These shifts can explain the high amount of venous admixture and physiological dead space found in this study. Breath holding redistributed ventilation toward dependent and ventral lung areas. The findings of this study reveal important pathophysiological insights into the changes in lung ventilation and perfusion during immobilization of white rhinoceroses. These novel insights might induce a search for better therapeutic options and is establishing EIT as a promising monitoring tool for large animals in the field.NEW & NOTEWORTHY Electrical impedance tomography measurements of regional ventilation and perfusion applied to etorphine-immobilized white rhinoceroses in lateral recumbency revealed a pronounced disproportional shift of the measured ventilation and perfusion toward the nondependent lung. The dependent lung was minimally ventilated and perfused, but still aerated. Perfusion was found primarily around the hilum of the nondependent lung. These shifts can explain the gas exchange impairments found in this study. Breath holding can redistribute ventilation.
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Affiliation(s)
- Martina Mosing
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Andreas D Waldmann
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Muriel Sacks
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Peter Buss
- Veterinary Wildlife Services, South African National Parks, Kruger National Park, Skukuza, South Africa
| | - Jordyn M Boesch
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Gareth E Zeiler
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa.,Centre for Veterinary Wildlife Studies and Department of Paraclinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - Giselle Hosgood
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Robin D Gleed
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Michele Miller
- Department of Science and Technology-National Research Foundation Centre of Excellence for Biomedical TB Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leith C R Meyer
- Centre for Veterinary Wildlife Studies and Department of Paraclinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - Stephan H Böhm
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
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284
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Spatenkova V, Teschner E, Jedlicka J. Evaluation of regional ventilation by electric impedance tomography during percutaneous dilatational tracheostomy in neurocritical care: a pilot study. BMC Neurol 2020; 20:374. [PMID: 33045989 PMCID: PMC7549221 DOI: 10.1186/s12883-020-01948-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/30/2020] [Indexed: 11/14/2022] Open
Abstract
Background Percutaneous dilatational tracheostomy (PDT) has become a widely performed technique in neurocritical care, which is however known to be accompanied by some risks to the patient. The aim of this pilot study was to assess the derecruitment effects of PDT with the electric impedance tomography (EIT) during the PDT procedure in neurocritical care. Methods The prospective observational pilot study investigated 11 adult, intubated, mechanically ventilated patients with acute brain disease. We recorded EIT data to determine regional ventilation delay standard deviation (RVD SD), compliance win (CW) and loss (CL), end-expiratory lung impedance (EELI), with the EIT belt placed at the level of Th 4 before, during and after the PDT, performed in the standard PDT position ensuring hyperextension of the neck. Results From 11 patients, we finally analyzed EIT data in 6 patients - EIT data of 5 patients have been excluded due to the insufficient EIT recordings. The mean RVD SD post-PDT decreased to 7.00 ± 1.29% from 7.33 ± 1.89%. The mean post-PDT CW was 27.33 ± 15.81 and PDT CL 6.33 ± 6.55. Only in one patient, where the trachea was open for 170 s, was a massive dorsal collapse (∆EELI − 25%) detected. In other patients, the trachea was open from 15 to 50 s. Conclusions This pilot study demonstrated the feasibility of EIT to detect early lung derecruitment occurring due to the PDT procedure. The ability to detect regional changes in ventilation could be helpful in predicting further progression of ventilation impairment and subsequent hypoxemia, to consider optimal ventilation regimes or time-schedule and type of recruitment maneuvres required after the PDT.
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Affiliation(s)
- Vera Spatenkova
- Neurocenter, Neurointensive Care Unit, Regional Hospital, Husova 357/10, 46063, Liberec, Czech Republic.
| | | | - Jaroslav Jedlicka
- Neurocenter, Neurointensive Care Unit, Regional Hospital, Husova 357/10, 46063, Liberec, Czech Republic
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285
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Hahn G, Niewenhuys J, Just A, Tonetti T, Behnemann T, Rapetti F, Collino F, Vasques F, Maiolo G, Romitti F, Gattinoni L, Quintel M, Moerer O. Monitoring lung impedance changes during long-term ventilator-induced lung injury ventilation using electrical impedance tomography. Physiol Meas 2020; 41:095011. [PMID: 33035199 DOI: 10.1088/1361-6579/abb1fb] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The target of this methodological evaluation was the feasibility of long-term monitoring of changes in lung conditions by time-difference electrical impedance tomography (tdEIT). In contrast to ventilation monitoring by tdEIT, the monitoring of end-expiratory (EELIC) or end-inspiratory (EILIC) lung impedance change always requires a reference measurement. APPROACH To determine the stability of the used Pulmovista 500® EIT system, as a prerequisite it was initially secured on a resistive phantom for 50 h. By comparing the slopes of EELIC for the whole lung area up to 48 h from 36 pigs ventilated at six positive end-expiratory pressure (PEEP) levels from 0 to 18 cmH2O we found a good agreement (range of r 2 = 0.93-1.0) between absolute EIT (aEIT) and tdEIT values. This justified the usage of tdEIT with its superior local resolution compared to aEIT for long-term determination of EELIC. MAIN RESULTS The EELIC was between -0.07 Ωm day-1 at PEEP 4 and -1.04 Ωm day-1 at PEEP 18 cmH2O. The complex local time pattern for EELIC was roughly quantified by the new parameter, centre of end-expiratory change (CoEEC), in equivalence to the established centre of ventilation (CoV). The ventrally located mean of the CoV was fairly constant in the range of 42%-46% of thorax diameter; however, on the contrary, the CoEEC shifted from about 40% to about 75% in the dorsal direction for PEEP levels of 14 and 18 cmH2O. SIGNIFICANCE The observed shifts started earlier for higher PEEP levels. Changes of EELI could be precisely monitored over a period of 48 h by tdEIT on pigs.
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Affiliation(s)
- G Hahn
- Department of Anaesthesiology, University Medical Center Göttingen (UMG), Robert-Koch-Str. 40, D-37075, Göttingen, Germany
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286
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Bonny V, Janiak V, Spadaro S, Pinna A, Demoule A, Dres M. Effect of PEEP decremental on respiratory mechanics, gasses exchanges, pulmonary regional ventilation, and hemodynamics in patients with SARS-Cov-2-associated acute respiratory distress syndrome. Crit Care 2020; 24:596. [PMID: 33023638 PMCID: PMC7538032 DOI: 10.1186/s13054-020-03311-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Vincent Bonny
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France.
| | - Vincent Janiak
- Sorbonne Université, UPMC Univ Paris 06, INSERM, Sorbonne Paris Cité, Université Paris 13, LIMICS, UMR_S 1142, Paris, France
- Bioserenity, 20 rue Berbier-du-Mets, 75013, Paris, France
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Anaesthesia and Intensive Care Unit, Sant'Anna Hospital, Aldo Moro, Ferrara, Italy
| | - Andrea Pinna
- Sorbonne Université, UPMC Univ Paris 06, INSERM, Sorbonne Paris Cité, Université Paris 13, LIMICS, UMR_S 1142, Paris, France
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
- AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France
| | - Martin Dres
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
- AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France
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Effects of pleural effusion drainage in the mechanically ventilated patient as monitored by electrical impedance tomography and end-expiratory lung volume: A pilot study. J Crit Care 2020; 59:76-80. [DOI: 10.1016/j.jcrc.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/25/2020] [Accepted: 06/01/2020] [Indexed: 12/17/2022]
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288
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Dalla Corte F, Mauri T, Spinelli E, Lazzeri M, Turrini C, Albanese M, Abbruzzese C, Lissoni A, Galazzi A, Eronia N, Bronco A, Maffezzini E, Pesenti A, Foti G, Bellani G, Grasselli G. Dynamic bedside assessment of the physiologic effects of prone position in acute respiratory distress syndrome patients by electrical impedance tomography. Minerva Anestesiol 2020; 86:1057-1064. [DOI: 10.23736/s0375-9393.20.14130-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sang L, Zhao Z, Yun PJ, Frerichs I, Möller K, Fu F, Liu X, Zhong N, Li Y. Qualitative and quantitative assessment of pendelluft: a simple method based on electrical impedance tomography. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1216. [PMID: 33178748 PMCID: PMC7607126 DOI: 10.21037/atm-20-4182] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Pendelluft, defined as asynchronous alveolar ventilation, is caused by different regional time constants or dynamic pleural pressure variations. The aim of the present study was to propose a simple method to evaluate pendelluft based on electrical impedance tomography (EIT). The efficacy of this method was demonstrated in well-known pendelluft scenarios in 6 patients. Methods Two patients with flail chest after accidents, two patients with acute respiratory distress syndrome (ARDS) and two patients with acutely exacerbated obstructive lung disease were prospectively included. EIT measurements were performed before and after surgery (in patients with flail chest, who had video-assisted thoracoscopic surgery with ribs fixation), or at two different levels of positive end-expiratory pressure (PEEP; ARDS patients), or two different time points (obstructive lung disease). Pendelluft was assessed by regional phase shift (defined as time difference between global and regional impedance-time curves) and amplitude differences (defined as the impedance difference between sum of all regional tidal variation and the global tidal variation). Results In patients with flail chest, pendelluft diminished several days after surgery (pendelluft amplitude normalized to tidal impedance variation reduced from 88% to 2% in one patient, 12% to 2% in the other). Increased PEEP reduced the amplitude of pendelluft (from 3% to 0% in one patient, 20% to 2% in the other) but not necessarily the phase shifts (average time differences were <0.1 second for both patients for both ins- and expiration) in ARDS patients. Pendelluft assessment in obstructive lung diseases reflected the change in airway resistance (from 5% to 1% in one patient after broncholytic medication administration, as airway resistance fell from 15 to 11 cmH2O/L/s; from 9% to 35% in the other patient with acute exacerbation, the corresponding airway resistance increased from 15 to 22 cmH2O/L/s). Conclusions The proposed EIT-based method can be used to evaluate the degree of pendelluft in dimension of phase shift and amplitude difference.
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Affiliation(s)
- Ling Sang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.,Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Po-Jen Yun
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, Taipei
| | - Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Knut Möller
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Feng Fu
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Xiaoqing Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Nanshan Zhong
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yimin Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou, China
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Tas J, van Gassel RJJ, Heines SJH, Mulder MMG, Heijnen NFL, Acampo-de Jong MJ, Bels JLM, Bennis FC, Koelmann M, Groven RVM, Donkers MA, van Rosmalen F, Hermans BJM, Meex SJ, Mingels A, Bekers O, Savelkoul P, Oude Lashof AML, Wildberger J, Tijssen FH, Buhre W, Sels JWEM, Ghossein-Doha C, Driessen RGH, Kubben PL, Janssen MLF, Nicolaes GAF, Strauch U, Geyik Z, Delnoij TSR, Walraven KHM, Stehouwer CDA, Verbunt JAMCF, Van Mook WNKA, van Santen S, Schnabel RM, Aries MJH, van de Poll MCG, Bergmans D, van der Horst ICC, van Kuijk S, van Bussel BCT. Serial measurements in COVID-19-induced acute respiratory disease to unravel heterogeneity of the disease course: design of the Maastricht Intensive Care COVID cohort (MaastrICCht). BMJ Open 2020; 10:e040175. [PMID: 32994259 PMCID: PMC7526030 DOI: 10.1136/bmjopen-2020-040175] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The course of the disease in SARS-CoV-2 infection in mechanically ventilated patients is unknown. To unravel the clinical heterogeneity of the SARS-CoV-2 infection in these patients, we designed the prospective observational Maastricht Intensive Care COVID cohort (MaastrICCht). We incorporated serial measurements that harbour aetiological, diagnostic and predictive information. The study aims to investigate the heterogeneity of the natural course of critically ill patients with a SARS-CoV-2 infection. METHODS AND ANALYSIS Mechanically ventilated patients admitted to the intensive care with a SARS-CoV-2 infection will be included. We will collect clinical variables, vital parameters, laboratory variables, mechanical ventilator settings, chest electrical impedance tomography, ECGs, echocardiography as well as other imaging modalities to assess heterogeneity of the course of a SARS-CoV-2 infection in critically ill patients. The MaastrICCht is also designed to foster various other studies and registries and intends to create an open-source database for investigators. Therefore, a major part of the data collection is aligned with an existing national intensive care data registry and two international COVID-19 data collection initiatives. Additionally, we create a flexible design, so that additional measures can be added during the ongoing study based on new knowledge obtained from the rapidly growing body of evidence. The spread of the COVID-19 pandemic requires the swift implementation of observational research to unravel heterogeneity of the natural course of the disease of SARS-CoV-2 infection in mechanically ventilated patients. Our study design is expected to enhance aetiological, diagnostic and prognostic understanding of the disease. This paper describes the design of the MaastrICCht. ETHICS AND DISSEMINATION Ethical approval has been obtained from the medical ethics committee (Medisch Ethische Toetsingscommissie 2020-1565/3 00 523) of the Maastricht University Medical Centre+ (Maastricht UMC+), which will be performed based on the Declaration of Helsinki. During the pandemic, the board of directors of Maastricht UMC+ adopted a policy to inform patients and ask their consent to use the collected data and to store serum samples for COVID-19 research purposes. All study documentation will be stored securely for fifteen years after recruitment of the last patient. The results will be published in peer-reviewed academic journals, with a preference for open access journals, while particularly considering deposition of the manuscripts on a preprint server early. TRIAL REGISTRATION NUMBER The Netherlands Trial Register (NL8613).
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Affiliation(s)
- Jeanette Tas
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Rob J J van Gassel
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Serge J H Heines
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Mark M G Mulder
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Nanon F L Heijnen
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Melanie J Acampo-de Jong
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Julia L M Bels
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Frank C Bennis
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marcel Koelmann
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rald V M Groven
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Moniek A Donkers
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Frank van Rosmalen
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Ben J M Hermans
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Steven Jr Meex
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Alma Mingels
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Otto Bekers
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Paul Savelkoul
- Department of Medical Microbiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Astrid M L Oude Lashof
- Department of Medical Microbiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Joachim Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Fabian H Tijssen
- Department of Anesthesiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Wolfgang Buhre
- Department of Anesthesiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jan-Willem E M Sels
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Chahinda Ghossein-Doha
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rob G H Driessen
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Pieter L Kubben
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marcus L F Janssen
- Department of Neurology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Gerry A F Nicolaes
- Department of Biochemistry, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ulrich Strauch
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Zafer Geyik
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Thijs S R Delnoij
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Kim H M Walraven
- Department of Pulmonology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Coen DA Stehouwer
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jeanine A M C F Verbunt
- Department of Rehabilitation Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Walther N K A Van Mook
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Susanne van Santen
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ronny M Schnabel
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marcel J H Aries
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Dennis Bergmans
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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291
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He H, Chi Y, Long Y, Yuan S, Frerichs I, Möller K, Fu F, Zhao Z. Influence of overdistension/recruitment induced by high positive end-expiratory pressure on ventilation-perfusion matching assessed by electrical impedance tomography with saline bolus. Crit Care 2020; 24:586. [PMID: 32993811 PMCID: PMC7523261 DOI: 10.1186/s13054-020-03301-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/21/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND High positive end-expiratory pressures (PEEP) may induce overdistension/recruitment and affect ventilation-perfusion matching (VQMatch) in mechanically ventilated patients. This study aimed to investigate the association between PEEP-induced lung overdistension/recruitment and VQMatch by electrical impedance tomography (EIT). METHODS The study was conducted prospectively on 30 adult mechanically ventilated patients: 18/30 with ARDS and 12/30 with high risk for ARDS. EIT measurements were performed at zero end-expiratory pressures (ZEEP) and subsequently at high (12-15 cmH2O) PEEP. The number of overdistended pixels over the number of recruited pixels (O/R ratio) was calculated, and the patients were divided into low O/R (O/R ratio < 15%) and high O/R groups (O/R ratio ≥ 15%). The global inhomogeneity (GI) index was calculated to evaluate the ventilation distribution. Lung perfusion image was calculated from the EIT impedance-time curves caused by 10 ml 10% NaCl injection during a respiratory pause (> 8 s). DeadSpace%, Shunt%, and VQMatch% were calculated based on lung EIT perfusion and ventilation images. RESULTS Increasing PEEP resulted in recruitment mainly in dorsal regions and overdistension mainly in ventral regions. ΔVQMatch% (VQMatch% at high PEEP minus that at ZEEP) was significantly correlated with recruited pixels (r = 0.468, P = 0.009), overdistended pixels (r = - 0.666, P < 0.001), O/R ratio (r = - 0.686, P < 0.001), and ΔSpO2 (r = 0.440, P = 0.015). Patients in the low O/R ratio group (14/30) had significantly higher Shunt% and lower VQMatch% than those in the high O/R ratio group (16/30) at ZEEP but not at high PEEP. Comparable DeadSpace% was found in both groups. A high PEEP caused a significant improvement of VQMatch%, DeadSpace%, Shunt%, and GI in the low O/R ratio group, but not in the high O/R ratio group. Using O/R ratio of 15% resulted in a sensitivity of 81% and a specificity of 100% for an increase of VQMatch% > 20% in response to high PEEP. CONCLUSIONS Change of ventilation-perfusion matching was associated with regional overdistention and recruitment induced by PEEP. A low O/R ratio induced by high PEEP might indicate a more homogeneous ventilation and improvement of VQMatch. TRIAL REGISTRATION ClinicalTrials.gov, NCT04081155 . Registered on 9 September 2019-retrospectively registered.
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Affiliation(s)
- Huaiwu He
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Chi
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
| | - Siyi Yuan
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center of Schleswig-Holstein Campus kiel, Kiel 24105, Germany
| | - Knut Möller
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Feng Fu
- Department of Biomedical Engineering, Fourth Military Medical University, 169 Changle Xi Rd, Xi'an, China
| | - Zhanqi Zhao
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany.
- Department of Biomedical Engineering, Fourth Military Medical University, 169 Changle Xi Rd, Xi'an, China.
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Brosnahan SB, Jonkman AH, Kugler MC, Munger JS, Kaufman DA. COVID-19 and Respiratory System Disorders: Current Knowledge, Future Clinical and Translational Research Questions. Arterioscler Thromb Vasc Biol 2020; 40:2586-2597. [PMID: 32960072 PMCID: PMC7571846 DOI: 10.1161/atvbaha.120.314515] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The severe acute respiratory syndrome coronavirus-2 emerged as a serious human pathogen in late 2019, causing the disease coronavirus disease 2019 (COVID-19). The most common clinical presentation of severe COVID-19 is acute respiratory failure consistent with the acute respiratory distress syndrome. Airway, lung parenchymal, pulmonary vascular, and respiratory neuromuscular disorders all feature in COVID-19. This article reviews what is known about the effects of severe acute respiratory syndrome coronavirus-2 infection on different parts of the respiratory system, clues to understanding the underlying biology of respiratory disease, and highlights current and future translation and clinical research questions.
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Affiliation(s)
- Shari B Brosnahan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU School of Medicine (S.B.B., M.C.K., J.S.M., D.A.K.)
| | - Annemijn H Jonkman
- Keenan Centre for Biomedical Research, Critical Care Department, St. Michael's Hospital, Toronto, Canada (A.H.J.).,Department of Intensive Care Medicine, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands (A.H.J.)
| | - Matthias C Kugler
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU School of Medicine (S.B.B., M.C.K., J.S.M., D.A.K.)
| | - John S Munger
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU School of Medicine (S.B.B., M.C.K., J.S.M., D.A.K.)
| | - David A Kaufman
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU School of Medicine (S.B.B., M.C.K., J.S.M., D.A.K.)
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293
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Aqueveque P, Gómez B, Monsalve E, Germany E, Ortega-Bastidas P, Dubo S, Pino EJ. Simple Wireless Impedance Pneumography System for Unobtrusive Sensing of Respiration. SENSORS 2020; 20:s20185228. [PMID: 32937770 PMCID: PMC7571009 DOI: 10.3390/s20185228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Abstract
This extended paper presents the development and implementation at a prototype level of a wireless, low-cost system for the measurement of the electrical bioimpedance of the chest with two channels using the AD5933 in a bipolar electrode configuration to measure impedance pneumography. The measurement device works for impedance measurements ranging from 1 Ω to 1800 Ω. Fifteen volunteers were measured with the prototype. We found that the left hemithorax has higher impedance compared to the right hemithorax, and the acquired signal presents the phases of the respiratory cycle with variations between 1 Ω, in normal breathing, to 6 Ω in maximum inhalation events. The system can measure the respiratory cycle variations simultaneously in both hemithorax with a mean error of -0.18 ± 1.42 BPM (breaths per minute) in the right hemithorax and -0.52 ± 1.31 BPM for the left hemithorax, constituting a useful device for the breathing rate calculation and possible screening applications.
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Affiliation(s)
- Pablo Aqueveque
- Electrical Engineering Department, Faculty of Engineering, Universidad de Concepción, Edmundo Larenas 219, Concepción 4070409, Chile; (P.A.); (B.G.); (E.M.); (E.G.)
| | - Britam Gómez
- Electrical Engineering Department, Faculty of Engineering, Universidad de Concepción, Edmundo Larenas 219, Concepción 4070409, Chile; (P.A.); (B.G.); (E.M.); (E.G.)
| | - Emyrna Monsalve
- Electrical Engineering Department, Faculty of Engineering, Universidad de Concepción, Edmundo Larenas 219, Concepción 4070409, Chile; (P.A.); (B.G.); (E.M.); (E.G.)
| | - Enrique Germany
- Electrical Engineering Department, Faculty of Engineering, Universidad de Concepción, Edmundo Larenas 219, Concepción 4070409, Chile; (P.A.); (B.G.); (E.M.); (E.G.)
| | - Paulina Ortega-Bastidas
- Kinesiology Department, Faculty of Medicine, Universidad de Concepción, Chacabuco 1401, Concepción 4070409, Chile; (P.O.-B.); (S.D.)
| | - Sebastián Dubo
- Kinesiology Department, Faculty of Medicine, Universidad de Concepción, Chacabuco 1401, Concepción 4070409, Chile; (P.O.-B.); (S.D.)
| | - Esteban J. Pino
- Electrical Engineering Department, Faculty of Engineering, Universidad de Concepción, Edmundo Larenas 219, Concepción 4070409, Chile; (P.A.); (B.G.); (E.M.); (E.G.)
- Correspondence: ; Tel.: +56-9-81989266
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Tomasino S, Sassanelli R, Marescalco C, Meroi F, Vetrugno L, Bove T. Electrical Impedance Tomography and Prone Position During Ventilation in COVID-19 Pneumonia: Case Reports and a Brief Literature Review. Semin Cardiothorac Vasc Anesth 2020; 24:287-292. [DOI: 10.1177/1089253220958912] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
At the end of 2019, a novel coronavirus (COVID-19) was identified as the cause of a cluster of pneumonia cases, with high needs of mechanical ventilation in critically ill patients. It is still unclear whether different types of COVID-19 pneumonia require different ventilator strategies. With electrical impedance tomography (EIT) we evaluated, in real time and bedside, the distribution of ventilation in the different pulmonary regions before, during, and after pronation in COVID-19 respiratory failure. We present a brief literature review of EIT in non-COVID-19 patients and a report of 2 COVID-19 patients: one that did not respond well and another one that improved during and after pronation. EIT might be a useful tool to decide whether prone positioning should or should not be used in COVID-19 pneumonia.
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Affiliation(s)
| | - Rosa Sassanelli
- University-Hospital of Udine, Udine, Italy
- University of Udine, Udine, Italy
| | - Corrado Marescalco
- University-Hospital of Udine, Udine, Italy
- University of Udine, Udine, Italy
| | - Francesco Meroi
- University-Hospital of Udine, Udine, Italy
- University of Udine, Udine, Italy
| | - Luigi Vetrugno
- University-Hospital of Udine, Udine, Italy
- University of Udine, Udine, Italy
| | - Tiziana Bove
- University-Hospital of Udine, Udine, Italy
- University of Udine, Udine, Italy
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295
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Fu Y, Zou R, Wang S, Wen J, Rong L, Tang M, Yu B, Cen F, Zhao Z, Frerichs I, Adler A, Liu Y, Liu L. Monitoring bronchoalveolar lavage with electrical impedance tomography: first experience in a patient with COVID-19. Physiol Meas 2020; 41:085008. [PMID: 32736369 DOI: 10.1088/1361-6579/abab1b] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Patients with the novel coronavirus disease (COVID-19) often have airway secretions that severely compromise ventilation. This study investigates electrical impedance tomography (EIT) monitoring of a therapeutic bronchoalveolar lavage (BAL) in a patient with COVID-19. APPROACH A patient with COVID-19 developed acute respiratory distress syndrome requiring mechanical ventilation. He received regional BAL to remove mucus in the small airways (20 ml × 5). Regional ventilation changes before BAL, 30 min after and in the following days, were monitored with EIT. MAIN RESULTS Regional ventilation worsened shortly after BAL and improved in the following days. The improvement of the oxygenation did not exactly match the ventilation improvement, which indicated a possible ventilation/perfusion mismatch. SIGNIFICANCE Therapeutic BAL might improve regional ventilation for COVID-19 and EIT could be a useful tool at the bedside to monitor the ventilation treatment of COVID-19.
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Affiliation(s)
- Yingyun Fu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, People's Republic of China. Authors contributed equally to this study
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Pinto TF, Fagundes Xavier R, Lunardi AC, Marques da Silva CCB, Moriya HT, Lima Vitorasso R, Torsani V, Amato MBP, Stelmach R, Salge JM, Carvalho-Pinto RM, Carvalho CR. Effects of elastic tape on thoracoabdominal mechanics, dyspnea, exercise capacity, and physical activity level in nonobese male subjects with COPD. J Appl Physiol (1985) 2020; 129:492-499. [DOI: 10.1152/japplphysiol.00690.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Elastic tape can be used as a new and low-cost intervention to reduce thoracoabdominal asynchrony and sedentary behavior as well as improve exercise capacity and physical activity level in nonobese male subjects with severe-to-very severe chronic obstructive pulmonary disease.
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Affiliation(s)
- Thiago Fernandes Pinto
- Department of Physical Therapy, Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Henrique Takachi Moriya
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
| | - Renato Lima Vitorasso
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
| | - Vinicius Torsani
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Marcelo Brito Passos Amato
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - João Marcos Salge
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Regina Maria Carvalho-Pinto
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Celso R.F. Carvalho
- Department of Physical Therapy, Medical School, University of São Paulo, São Paulo, Brazil
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297
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Sella N, Zarantonello F, Andreatta G, Gagliardi V, Boscolo A, Navalesi P. Positive end-expiratory pressure titration in COVID-19 acute respiratory failure: electrical impedance tomography vs. PEEP/FiO 2 tables. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:540. [PMID: 32873337 PMCID: PMC7459241 DOI: 10.1186/s13054-020-03242-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Nicolò Sella
- Department of Medicine - DIMEDD, University of Padua, via V. Gallucci 13, 35125, Padua, Italy
| | - Francesco Zarantonello
- Anaesthesia and Intensive Care Unit, Padua University Hospital, via V. Gallucci 13, 35125, Padua, Italy
| | - Giulio Andreatta
- Department of Medicine - DIMEDD, University of Padua, via V. Gallucci 13, 35125, Padua, Italy
| | - Veronica Gagliardi
- Department of Medicine - DIMEDD, University of Padua, via V. Gallucci 13, 35125, Padua, Italy
| | - Annalisa Boscolo
- Anaesthesia and Intensive Care Unit, Padua University Hospital, via V. Gallucci 13, 35125, Padua, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMEDD, University of Padua, via V. Gallucci 13, 35125, Padua, Italy. .,Anaesthesia and Intensive Care Unit, Padua University Hospital, via V. Gallucci 13, 35125, Padua, Italy.
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298
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Scaramuzzo G, Spadaro S, Dalla Corte F, Waldmann AD, Böhm SH, Ragazzi R, Marangoni E, Grasselli G, Pesenti A, Volta CA, Mauri T. Personalized Positive End-Expiratory Pressure in Acute Respiratory Distress Syndrome: Comparison Between Optimal Distribution of Regional Ventilation and Positive Transpulmonary Pressure. Crit Care Med 2020; 48:1148-1156. [PMID: 32697485 DOI: 10.1097/ccm.0000000000004439] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Different techniques exist to select personalized positive end-expiratory pressure in patients affected by the acute respiratory distress syndrome. The positive end-expiratory transpulmonary pressure strategy aims to counteract dorsal lung collapse, whereas electrical impedance tomography could guide positive end-expiratory pressure selection based on optimal homogeneity of ventilation distribution. We compared the physiologic effects of positive end-expiratory pressure guided by electrical impedance tomography versus transpulmonary pressure in patients affected by acute respiratory distress syndrome. DESIGN Cross-over prospective physiologic study. SETTING Two academic ICUs. PATIENTS Twenty ICU patients affected by acute respiratory distress syndrome undergoing mechanical ventilation. INTERVENTION Patients monitored by an esophageal catheter and a 32-electrode electrical impedance tomography monitor underwent two positive end-expiratory pressure titration trials by randomized cross-over design to find the level of positive end-expiratory pressure associated with: 1) positive end-expiratory transpulmonary pressure (PEEPPL) and 2) proportion of poorly or nonventilated lung units (Silent Spaces) less than or equal to 15% (PEEPEIT). Each positive end-expiratory pressure level was maintained for 20 minutes, and afterward, lung mechanics, gas exchange, and electrical impedance tomography data were collected. MEASUREMENTS AND MAIN RESULTS PEEPEIT and PEEPPL differed in all patients, and there was no correlation between the levels identified by the two methods (Rs = 0.25; p = 0.29). PEEPEIT determined a more homogeneous distribution of ventilation with a lower percentage of dependent Silent Spaces (p = 0.02), whereas PEEPPL was characterized by lower airway-but not transpulmonary-driving pressure (p = 0.04). PEEPEIT was significantly higher than PEEPPL in subjects with extrapulmonary acute respiratory distress syndrome (p = 0.006), whereas the opposite was true for pulmonary acute respiratory distress syndrome (p = 0.03). CONCLUSIONS Personalized positive end-expiratory pressure levels selected by electrical impedance tomography- and transpulmonary pressure-based methods are not correlated at the individual patient level. PEEPPL is associated with lower dynamic stress, whereas PEEPEIT may help to optimize lung recruitment and homogeneity of ventilation. The underlying etiology of acute respiratory distress syndrome could deeply influence results from each method.
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Affiliation(s)
- Gaetano Scaramuzzo
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Francesca Dalla Corte
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Andreas D Waldmann
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Stephan H Böhm
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Elisabetta Marangoni
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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299
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Schumann S, Feth A, Borgmann S, Wirth S. Dependency of respiratory system mechanics on positive end-expiratory pressure and recruitment maneuvers in lung healthy pediatric patients-A randomized crossover study. Paediatr Anaesth 2020; 30:905-911. [PMID: 32445609 DOI: 10.1111/pan.13927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The lungs of pediatric patients are subjected to tidal derecruitment during mechanical ventilation and in contrast to adult patients this unfavorable condition cannot be resolved with small c increases. This raises the question if higher end-expiratory pressure increases or recruitment maneuvers may resolve tidal derecruitment in pediatric patients. AIMS We hypothesized that higher PEEP resolves tidal derecruitment in pediatric patients and that recruitment maneuvers between the pressure changes support the improvement of respiratory system mechanics. METHODS The effects of end-expiratory pressure changes from 3 to 7 cmH2 O and vice versa without and with intermediate recruitment maneuvers on respiratory system mechanics and regional ventilation were investigated in 57 mechanically ventilated pediatric patients. The intratidal respiratory system compliance was determined from volume and pressure data before and after PEEP changes and categorized to indicate tidal derecruitment. RESULTS Tidal derecruitment occurred comparably frequently at PEEP 3 cmH2 O without (13 out of 14 cases) and with recruitment maneuver (14 out of 14 cases) and at PEEP 7 cmH2 O without (13 out of 14 cases) and with recruitment maneuver (13 out of 15 cases). CONCLUSIONS We conclude that contrary to our hypothesis, PEEP up to 7 cmH2 O is not sufficient to resolve tidal derecruitment and that recruitment maneuvers may be dispensable in mechanically ventilated pediatric patients.
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Affiliation(s)
- Stefan Schumann
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Arne Feth
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Silke Borgmann
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Steffen Wirth
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
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300
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Ferreira AH, Pazin-Filho A. Lung Ultrasound in a Patient With ARDS Secondary to Pancreatitis. Chest 2020; 158:e85-e87. [DOI: 10.1016/j.chest.2019.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/19/2019] [Accepted: 09/01/2019] [Indexed: 10/23/2022] Open
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