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Bachmann MC, Cruces P, Díaz F, Oviedo V, Goich M, Fuenzalida J, Damiani LF, Basoalto R, Jalil Y, Carpio D, Hamidi Vadeghani N, Cornejo R, Rovegno M, Bugedo G, Bruhn A, Retamal J. Spontaneous breathing promotes lung injury in an experimental model of alveolar collapse. Sci Rep 2022; 12:12648. [PMID: 35879511 PMCID: PMC9310356 DOI: 10.1038/s41598-022-16446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Vigorous spontaneous breathing has emerged as a promotor of lung damage in acute lung injury, an entity known as “patient self-inflicted lung injury”. Mechanical ventilation may prevent this second injury by decreasing intrathoracic pressure swings and improving regional air distribution. Therefore, we aimed to determine the effects of spontaneous breathing during the early stage of acute respiratory failure on lung injury and determine whether early and late controlled mechanical ventilation may avoid or revert these harmful effects. A model of partial surfactant depletion and lung collapse was induced in eighteen intubated pigs of 32 ±4 kg. Then, animals were randomized to (1) SB‐group: spontaneous breathing with very low levels of pressure support for the whole experiment (eight hours), (2) Early MV-group: controlled mechanical ventilation for eight hours, or (3) Late MV-group: first half of the experiment on spontaneous breathing (four hours) and the second half on controlled mechanical ventilation (four hours). Respiratory, hemodynamic, and electric impedance tomography data were collected. After the protocol, animals were euthanized, and lungs were extracted for histologic tissue analysis and cytokines quantification. SB-group presented larger esophageal pressure swings, progressive hypoxemia, lung injury, and more dorsal and inhomogeneous ventilation compared to the early MV-group. In the late MV-group switch to controlled mechanical ventilation improved the lung inhomogeneity and esophageal pressure swings but failed to prevent hypoxemia and lung injury. In a lung collapse model, spontaneous breathing is associated to large esophageal pressure swings and lung inhomogeneity, resulting in progressive hypoxemia and lung injury. Mechanical ventilation prevents these mechanisms of patient self-inflicted lung injury if applied early, before spontaneous breathing occurs, but not when applied late.
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Affiliation(s)
- María Consuelo Bachmann
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Cruces
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile.,Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago, Chile
| | - Franco Díaz
- Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago, Chile.,Escuela de Postgrado, Universidad Finis Terrae, Santiago, Chile
| | - Vanessa Oviedo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mariela Goich
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - José Fuenzalida
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Luis Felipe Damiani
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Ciencias de La Salud, Carrera de Kinesiología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roque Basoalto
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yorschua Jalil
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Ciencias de La Salud, Carrera de Kinesiología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David Carpio
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Niki Hamidi Vadeghani
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Cornejo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Maximiliano Rovegno
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Guillermo Bugedo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Bruhn
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Brabant OA, Byrne DP, Sacks M, Moreno Martinez F, Raisis AL, Araos JB, Waldmann AD, Schramel JP, Ambrosio A, Hosgood G, Braun C, Auer U, Bleul U, Herteman N, Secombe CJ, Schoster A, Soares J, Beazley S, Meira C, Adler A, Mosing M. Thoracic Electrical Impedance Tomography-The 2022 Veterinary Consensus Statement. Front Vet Sci 2022; 9:946911. [PMID: 35937293 PMCID: PMC9354895 DOI: 10.3389/fvets.2022.946911] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Electrical impedance tomography (EIT) is a non-invasive real-time non-ionising imaging modality that has many applications. Since the first recorded use in 1978, the technology has become more widely used especially in human adult and neonatal critical care monitoring. Recently, there has been an increase in research on thoracic EIT in veterinary medicine. Real-time imaging of the thorax allows evaluation of ventilation distribution in anesthetised and conscious animals. As the technology becomes recognised in the veterinary community there is a need to standardize approaches to data collection, analysis, interpretation and nomenclature, ensuring comparison and repeatability between researchers and studies. A group of nineteen veterinarians and two biomedical engineers experienced in veterinary EIT were consulted and contributed to the preparation of this statement. The aim of this consensus is to provide an introduction to this imaging modality, to highlight clinical relevance and to include recommendations on how to effectively use thoracic EIT in veterinary species. Based on this, the consensus statement aims to address the need for a streamlined approach to veterinary thoracic EIT and includes: an introduction to the use of EIT in veterinary species, the technical background to creation of the functional images, a consensus from all contributing authors on the practical application and use of the technology, descriptions and interpretation of current available variables including appropriate statistical analysis, nomenclature recommended for consistency and future developments in thoracic EIT. The information provided in this consensus statement may benefit researchers and clinicians working within the field of veterinary thoracic EIT. We endeavor to inform future users of the benefits of this imaging modality and provide opportunities to further explore applications of this technology with regards to perfusion imaging and pathology diagnosis.
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Affiliation(s)
- Olivia A. Brabant
- School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
| | - David P. Byrne
- School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
| | - Muriel Sacks
- School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
| | | | - Anthea L. Raisis
- School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
| | - Joaquin B. Araos
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Andreas D. Waldmann
- Department of Anaesthesiology and Intensive Care Medicine, Rostock University Medical Centre, Rostock, Germany
| | - Johannes P. Schramel
- Department of Anaesthesiology and Perioperative Intensive Care Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Aline Ambrosio
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Giselle Hosgood
- School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
| | - Christina Braun
- Department of Anaesthesiology and Perioperative Intensive Care Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Ulrike Auer
- Department of Anaesthesiology and Perioperative Intensive Care Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Ulrike Bleul
- Clinic of Reproductive Medicine, Department of Farm Animals, Vetsuisse-Faculty University Zurich, Zurich, Switzerland
| | - Nicolas Herteman
- Clinic for Equine Internal Medicine, Equine Hospital, Vetsuisse-Faculty, University of Zurich, Zurich, Switzerland
| | - Cristy J. Secombe
- School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
| | - Angelika Schoster
- Clinic for Equine Internal Medicine, Equine Hospital, Vetsuisse-Faculty, University of Zurich, Zurich, Switzerland
| | - Joao Soares
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Shannon Beazley
- Department of Small Animal Clinical Sciences, Western College Veterinary Medicine, Saskatoon, SK, Canada
| | - Carolina Meira
- Department of Clinical Diagnostics and Services, Anaesthesiology, Vetsuisse-Faculty, University of Zurich, Zurich, Switzerland
| | - Andy Adler
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - Martina Mosing
- School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
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Hochhausen N, Orschulik J, Follmann A, Santos SA, Dohmeier H, Leonhardt S, Rossaint R, Czaplik M. Comparison of two experimental ARDS models in pigs using electrical impedance tomography. PLoS One 2019; 14:e0225218. [PMID: 31721803 PMCID: PMC6853608 DOI: 10.1371/journal.pone.0225218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Animal trials contribute to major achievements in medical science. The so-called lavage model is frequently used to evaluate ventilation strategies in acute respiratory distress syndrome (ARDS) using electrical impedance tomography (EIT). But, the lavage model itself might have systematic impacts on EIT parameters. Therefore, we established an additional experimental model, in which ARDS is caused by intravenously administered lipopolysaccharide (LPS). In this study, we want to examine if EIT measurements provide consistent results in both experimental models or whether the pathophysiology of the model influences the findings. Overall, we want to compare both experimental models regarding clinical parameters and EIT-derived indices, namely the global inhomogeneity (GI) index and the regional ventilation delay (RVD) index. METHODS Nineteen pigs were included in this study, allocated to the control group (CO; n = 5), lavage group (LAV; n = 7) and LPS group (LPS; n = 7). After baseline measurements and the establishment of ARDS, assessment of respiratory mechanics, hemodynamics, gas exchange and EIT recordings were performed hourly over eight hours. RESULTS In both experimental ARDS models, EIT measurements provided reliable results. But, the GI and the RVD index did not show consistent results as compared to the CO group. Initially, GI and RVD index were higher in the LAV group but not in the LPS group as compared to the CO group. This effect disappeared during the study. Furthermore, the GI index and the RVD index were higher in the LAV group compared to the LPS group in the beginning as well. This, once again, disappeared. Clinical lung injury parameters remained more stable when using LPS. CONCLUSION The two models showed quite different influences on the GI and RVD index. This implies, that the underlying pathophysiology affects EIT parameters and thus the findings. Hence, translation to EIT-guided clinical therapy in humans suffering from ARDS might be limited.
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Affiliation(s)
- Nadine Hochhausen
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jakob Orschulik
- Philips Chair for Medical Information Technology, RWTH Aachen University, Aachen, Germany
| | - Andreas Follmann
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Susana Aguiar Santos
- Philips Chair for Medical Information Technology, RWTH Aachen University, Aachen, Germany
| | - Henriette Dohmeier
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Steffen Leonhardt
- Philips Chair for Medical Information Technology, RWTH Aachen University, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Michael Czaplik
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Bachmann MC, Morais C, Bugedo G, Bruhn A, Morales A, Borges JB, Costa E, Retamal J. Electrical impedance tomography in acute respiratory distress syndrome. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:263. [PMID: 30360753 PMCID: PMC6203288 DOI: 10.1186/s13054-018-2195-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/14/2018] [Indexed: 12/29/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is a clinical entity that acutely affects the lung parenchyma, and is characterized by diffuse alveolar damage and increased pulmonary vascular permeability. Currently, computed tomography (CT) is commonly used for classifying and prognosticating ARDS. However, performing this examination in critically ill patients is complex, due to the need to transfer these patients to the CT room. Fortunately, new technologies have been developed that allow the monitoring of patients at the bedside. Electrical impedance tomography (EIT) is a monitoring tool that allows one to evaluate at the bedside the distribution of pulmonary ventilation continuously, in real time, and which has proven to be useful in optimizing mechanical ventilation parameters in critically ill patients. Several clinical applications of EIT have been developed during the last years and the technique has been generating increasing interest among researchers. However, among clinicians, there is still a lack of knowledge regarding the technical principles of EIT and potential applications in ARDS patients. The aim of this review is to present the characteristics, technical concepts, and clinical applications of EIT, which may allow better monitoring of lung function during ARDS.
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Affiliation(s)
- M Consuelo Bachmann
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Acute Respiratory and Critical Illness Center (ARCI), Santiago, Chile
| | - Caio Morais
- Divisao de Pneumologia, Instituto do Coracao (Incor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Guillermo Bugedo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Acute Respiratory and Critical Illness Center (ARCI), Santiago, Chile
| | - Alejandro Bruhn
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Acute Respiratory and Critical Illness Center (ARCI), Santiago, Chile
| | - Arturo Morales
- Departamento Enfermedades Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - João B Borges
- Divisao de Pneumologia, Instituto do Coracao (Incor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Hedenstierna Laboratory, Department of Surgical Sciences, Section of Anaesthesiology and Critical Care, Uppsala University, Uppsala, Sweden
| | - Eduardo Costa
- Divisao de Pneumologia, Instituto do Coracao (Incor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Acute Respiratory and Critical Illness Center (ARCI), Santiago, Chile.
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Trenk F, Mendes L, Carvalho P, Paiva RP, Henriques J, Maglaveras N, Chouvarda I, Tsara V, Teixeira CA. Evaluation of lung ventilation distribution in chronic obstructive pulmonary disease patients using the global inhomogeneity index. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:5286-5289. [PMID: 28325021 DOI: 10.1109/embc.2016.7591920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The global inhomogeneity (GI) index is a electrical impedance tomography (EIT) parameter that quantifies the tidal volume distribution within the lung. In this work the global inhomogeneity index was computed for twenty subjects in order to evaluate his potential use in the detection and follow up of chronic obstructive pulmonary disease (COPD) patients. EIT data of 17 subjects were acquired: 14 patients with the main diagnoses of COPD and 3 healthy subjects which served as a control group. Two or three datasets of around 30 seconds were acquired at 33 scans/s and analysed for each subject. After reconstruction, a tidal EIT image was computed for each breathing cycle and a GI index calculated from it. Results have shown significant differences in GI values between the two groups (0.745 ± 0.007 for COPD and 0.668 ± 0.006 for lung-healthy subject, p <; 0.005). The GI values obtained for each subject have shown small variance between them, which is a good indication of stability. The results suggested that the GI may be useful for the identification and follow up of ventilation problems in patients with COPD.
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Kobylianskii J, Murray A, Brace D, Goligher E, Fan E. Electrical impedance tomography in adult patients undergoing mechanical ventilation: A systematic review. J Crit Care 2016; 35:33-50. [PMID: 27481734 DOI: 10.1016/j.jcrc.2016.04.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of the study is to systematically review and summarize current literature concerning the validation and application of electrical impedance tomography (EIT) in mechanically ventilated adult patients. MATERIALS AND METHODS An electronic search of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and the Web of Science was performed up to June 2014. Studies investigating the use of EIT in an adult human patient population treated with mechanical ventilation (MV) were included. Data extracted included study objectives, EIT details, interventions, MV protocol, validation and comparators, population characteristics, and key findings. RESULTS Of the 67 included studies, 35 had the primary objective of validating EIT measures including regional ventilation distribution, lung volume, regional respiratory mechanics, and nonventilatory parameters. Thirty-two studies had the primary objective of applying EIT to monitor the response to therapeutic MV interventions including change in ventilation mode, patient repositioning, endotracheal suctioning, recruitment maneuvers, and change in positive end-expiratory pressure. CONCLUSIONS In adult patients, EIT has been successfully validated for assessing ventilation distribution, measuring changes in lung volume, studying regional respiratory mechanics, and investigating nonventilatory parameters. Electrical impedance tomography has also been demonstrated to be useful in monitoring regional respiratory system changes during MV interventions, although existing literature lacks clinical outcome evidence.
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Affiliation(s)
- Jane Kobylianskii
- School of Medicine, Queen's University, Kingston, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Alistair Murray
- Schulich School of Medicine & Dentistry, Western University, London, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Debbie Brace
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Ewan Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
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