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Arriagada R, Bachmann MC, San Martin C, Rauseo M, Battaglini D. Electrical impedance tomography: Usefulness for respiratory physiotherapy in critical illnesses. Med Intensiva 2024; 48:403-410. [PMID: 38538496 DOI: 10.1016/j.medine.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/26/2024] [Indexed: 07/05/2024]
Abstract
Respiratory physiotherapy, including the management of invasive mechanical ventilation (MV) and noninvasive mechanical ventilation (NIV), is a key supportive intervention for critically ill patients. MV has potential for inducing ventilator-induced lung injury (VILI) as well as long-term complications related to prolonged bed rest, such as post-intensive care syndrome and intensive care unit acquired weakness. Physical and respiratory therapy, developed by the critical care team, in a timely manner, has been shown to prevent these complications. In this pathway, real-time bedside monitoring of changes in pulmonary aeration and alveolar gas distribution associated with postural positioning, respiratory physiotherapy techniques and changes in MV strategies can be crucial in guiding these procedures, providing safe therapy and prevention of potential harm to the patient. Along this path, electrical impedance tomography (EIT) has emerged as a new key non-invasive bedside strategy free of radiation, to allow visualization of lung recruitment. This review article presents the main and potential applications of EIT in relation to physiotherapy techniques in the ICU setting.
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Affiliation(s)
- Ricardo Arriagada
- Unidad de Paciente Crítico Adulto, Hospital Las Higueras de Talcahuano, Chile; Escuela de Kinesiología Universidad San Sebastián, Sede Tres Pascualas, Concepción, Chile; Unidad de Paciente Crìtico, Clìnica Biobìo, Hualpén, Chile
| | - María Consuelo Bachmann
- Unidad de Paciente Crítico Adulto, Hospital Clínico Pontificia Universidad Católica de Chile, Escuela de Kinesiología, Universidad de Los Andes, Santiago, Chile
| | - Constanza San Martin
- Unidad de Paciente Crítico Adulto, Hospital Las Higueras de Talcahuano, Chile; Escuela de Kinesiología Universidad San Sebastián, Sede Tres Pascualas, Concepción, Chile
| | - Michela Rauseo
- Anesthesia and Intensive Care Medicine, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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Coudroy R, Lejars A, Rodriguez M, Frat JP, Rault C, Arrivé F, Le Pape S, Thille AW. Physiologic Effects of Reconnection to the Ventilator for 1 Hour Following a Successful Spontaneous Breathing Trial. Chest 2024; 165:1406-1414. [PMID: 38295948 DOI: 10.1016/j.chest.2024.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Reconnection to the ventilator for 1 h following a successful spontaneous breathing trial (SBT) may reduce reintubation rates compared with direct extubation. However, the physiologic mechanisms leading to this effect are unclear. RESEARCH QUESTION Does reconnection to the ventilator for 1 h reverse alveolar derecruitment induced by SBT, and is alveolar derecruitment more pronounced with a T-piece than with pressure-support ventilation (PSV)? STUDY DESIGN AND METHODS This is an ancillary study of a randomized clinical trial comparing SBT performed with a T-piece or with PSV. Alveolar recruitment was assessed by using measurement of end-expiratory lung volume (EELV). RESULTS Of the 25 patients analyzed following successful SBT, 11 underwent SBT with a T-piece and 14 with PSV. At the end of the SBT, EELV decreased by -30% (95% CI, -37 to -23) compared with baseline prior to the SBT. This reduction was greater with a T-piece than with PSV: -43% (95% CI, -51 to -35) vs -20% (95% CI, -26 to -13); P < .001. Following reconnection to the ventilator for 1 h, EELV accounted for 96% (95% CI, 92 to 101) of baseline EELV and did not significantly differ from prior to the SBT (P = .104). Following 10 min of reconnection to the ventilator, EELV wasted at the end of the SBT was completely recovered using PSV (P = .574), whereas it remained lower than prior to the SBT using a T-piece (P = .010). INTERPRETATION Significant alveolar derecruitment was observed at the end of an SBT and was markedly more pronounced with a T-piece than with PSV. Reconnection to the ventilator for 1 h allowed complete recovery of alveolar derecruitment. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT04227639; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Rémi Coudroy
- CHU de Poitiers, Service de Médecine Intensive Réanimation, Poitiers, France; INSERM CIC 1402, IS-ALIVE Research Group, Université de Poitiers, Poitiers, France.
| | - Alice Lejars
- CHU de Poitiers, Service de Médecine Intensive Réanimation, Poitiers, France
| | - Maeva Rodriguez
- CHU de Poitiers, Service de Médecine Intensive Réanimation, Poitiers, France
| | - Jean-Pierre Frat
- CHU de Poitiers, Service de Médecine Intensive Réanimation, Poitiers, France; INSERM CIC 1402, IS-ALIVE Research Group, Université de Poitiers, Poitiers, France
| | - Christophe Rault
- INSERM CIC 1402, IS-ALIVE Research Group, Université de Poitiers, Poitiers, France; CHU de Poitiers, Service d'Explorations Fonctionnelles, de Physiologie Respiratoire et de l'Exercice, Poitiers, France
| | - François Arrivé
- CHU de Poitiers, Service de Médecine Intensive Réanimation, Poitiers, France
| | - Sylvain Le Pape
- CHU de Poitiers, Service de Médecine Intensive Réanimation, Poitiers, France
| | - Arnaud W Thille
- CHU de Poitiers, Service de Médecine Intensive Réanimation, Poitiers, France; INSERM CIC 1402, IS-ALIVE Research Group, Université de Poitiers, Poitiers, France
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Franchineau G, Jonkman AH, Piquilloud L, Yoshida T, Costa E, Rozé H, Camporota L, Piraino T, Spinelli E, Combes A, Alcala GC, Amato M, Mauri T, Frerichs I, Brochard LJ, Schmidt M. Electrical Impedance Tomography to Monitor Hypoxemic Respiratory Failure. Am J Respir Crit Care Med 2024; 209:670-682. [PMID: 38127779 DOI: 10.1164/rccm.202306-1118ci] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023] Open
Abstract
Hypoxemic respiratory failure is one of the leading causes of mortality in intensive care. Frequent assessment of individual physiological characteristics and delivery of personalized mechanical ventilation (MV) settings is a constant challenge for clinicians caring for these patients. Electrical impedance tomography (EIT) is a radiation-free bedside monitoring device that is able to assess regional lung ventilation and changes in aeration. With real-time tomographic functional images of the lungs obtained through a thoracic belt, clinicians can visualize and estimate the distribution of ventilation at different ventilation settings or following procedures such as prone positioning. Several studies have evaluated the performance of EIT to monitor the effects of different MV settings in patients with acute respiratory distress syndrome, allowing more personalized MV. For instance, EIT could help clinicians find the positive end-expiratory pressure that represents a compromise between recruitment and overdistension and assess the effect of prone positioning on ventilation distribution. The clinical impact of the personalization of MV remains to be explored. Despite inherent limitations such as limited spatial resolution, EIT also offers a unique noninvasive bedside assessment of regional ventilation changes in the ICU. This technology offers the possibility of a continuous, operator-free diagnosis and real-time detection of common problems during MV. This review provides an overview of the functioning of EIT, its main indices, and its performance in monitoring patients with acute respiratory failure. Future perspectives for use in intensive care are also addressed.
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Affiliation(s)
- Guillaume Franchineau
- Service de Medecine Intensive Reanimation, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Annemijn H Jonkman
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lise Piquilloud
- Adult Intensive Care Unit, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eduardo Costa
- Pulmonary Division, Cardiopulmonary Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Hadrien Rozé
- Department of Thoraco-Abdominal Anesthesiology and Intensive Care, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
- Réanimation Polyvalente, Centre Hospitalier Côte Basque, Bayonne, France
| | - Luigi Camporota
- Health Centre for Human and Applied Physiological Sciences, Department of Adult Critical Care, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Thomas Piraino
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Critical Care, Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Elena Spinelli
- Department of Anesthesia, Critical Care and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alain Combes
- Sorbonne Université, Groupe de Recherche Clinique 30, Réanimation et Soins Intensifs du Patient en Insuffisance Respiratoire Aigüe, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive - Réanimation, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France
| | - Glasiele C Alcala
- Pulmonary Division, Cardiopulmonary Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Marcelo Amato
- Pulmonary Division, Cardiopulmonary Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplants, University of Milan, Milan, Italy
| | - Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Centre of Schleswig-Holstein Campus Kiel, Kiel, Germany; and
| | - Laurent J Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Matthieu Schmidt
- Sorbonne Université, Groupe de Recherche Clinique 30, Réanimation et Soins Intensifs du Patient en Insuffisance Respiratoire Aigüe, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive - Réanimation, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France
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Gaertner VD, Büchler VL, Waldmann A, Bassler D, Rüegger CM. Deciphering Mechanisms of Respiratory Fetal-to-Neonatal Transition in Very Preterm Infants. Am J Respir Crit Care Med 2024; 209:738-747. [PMID: 38032260 DOI: 10.1164/rccm.202306-1021oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/30/2023] [Indexed: 12/01/2023] Open
Abstract
Rationale: The respiratory mechanisms of a successful transition of preterm infants after birth are largely unknown. Objectives: To describe intrapulmonary gas flows during different breathing patterns directly after birth. Methods: Analysis of electrical impedance tomography data from a previous randomized trial in preterm infants at 26-32 weeks gestational age. Electrical impedance tomography data for individual breaths were extracted, and lung volumes as well as ventilation distribution were calculated for end of inspiration, end of expiratory braking and/or holding maneuver, and end of expiration. Measurements and Main Results: Overall, 10,348 breaths from 33 infants were analyzed. We identified three distinct breath types within the first 10 minutes after birth: tidal breathing (44% of all breaths; sinusoidal breathing without expiratory disruption), braking (50%; expiratory brake with a short duration), and holding (6%; expiratory brake with a long duration). Only after holding breaths did end-expiratory lung volume increase: Median (interquartile range [IQR]) = 2.0 AU/kg (0.6 to 4.3), 0.0 (-1.0 to 1.1), and 0.0 (-1.1 to 0.4), respectively; P < 0.001]. This was mediated by intrathoracic air redistribution to the left and non-gravity-dependent parts of the lung through pendelluft gas flows during braking and/or holding maneuvers. Conclusions: Respiratory transition in preterm infants is characterized by unique breathing patterns. Holding breaths contribute to early lung aeration after birth in preterm infants. This is facilitated by air redistribution during braking/holding maneuvers through pendelluft flow, which may prevent lung liquid reflux in this highly adaptive situation. This study deciphers mechanisms for a successful fetal-to-neonatal transition and increases our pathophysiological understanding of this unique moment in life. Clinical trial registered with www.clinicaltrials.gov (NCT04315636).
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Affiliation(s)
- Vincent D Gaertner
- Newborn Research, Department of Neonatology, University Hospital Zurich and University of Zürich, Zürich, Switzerland
- Division of Neonatology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Vanessa L Büchler
- Newborn Research, Department of Neonatology, University Hospital Zurich and University of Zürich, Zürich, Switzerland
| | - Andreas Waldmann
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Dirk Bassler
- Newborn Research, Department of Neonatology, University Hospital Zurich and University of Zürich, Zürich, Switzerland
| | - Christoph M Rüegger
- Newborn Research, Department of Neonatology, University Hospital Zurich and University of Zürich, Zürich, Switzerland
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Yildirim S, Saygili SM, Süneçli O, Kirakli C. Comparison of the effects of open and closed aspiration on end-expiratory lung volume in acute respiratory distress syndrome. Korean J Anesthesiol 2024; 77:115-121. [PMID: 37211764 PMCID: PMC10834727 DOI: 10.4097/kja.23194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/20/2023] [Accepted: 05/21/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Alveoli tend to collapse in patients with acute respiratory distress syndrome (ARDS). Endotracheal aspiration may increase alveolar collapse due to the loss of end-expiratory lung volume (EELV). We aimed to compare the loss of EELV after open and closed suction in patients with ARDS. METHODS This randomized crossover study included 20 patients receiving invasive mechanical ventilation for ARDS. Open and closed suction were applied in a random order. Lung impedance was measured using electric impedance tomography. The change in end-expiratory lung impedance end of suction and at 1, 10, 20, and 30 min after suction, was used to represent the change in EELV. Arterial blood gas analyses and ventilatory parameters such as the plateau pressure (Pplat), driving pressure (Pdrive), and compliance of the respiratory system (CRS) were also recorded. RESULTS Less volume loss was noted after closed suction than after open suction (mean ΔEELI: -2661 ± 1937 vs. -4415 ± 2363; mean difference: -1753; 95% CI [-2662, -844]; P = 0.001). EELI returned to baseline 10 min after closed suction but did not return to baseline even 30 min after open suction. After closed suction, the Pplat and Pdrive decreased while the CRS increased. Conversely, the Pplat and Pdrive increased while the CRS decreased after open suction. CONCLUSIONS Endotracheal aspiration may result in alveolar collapse due to loss of EELV. Given that closed suction is associated with less volume loss at end-expiration without worsening ventilatory parameters, it should be chosen over open suction in patients with ARDS.
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Affiliation(s)
- Süleyman Yildirim
- Intensive Care Unit, University of Health Sciences Turkey, İzmir School of Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Saba Mukaddes Saygili
- Intensive Care Unit, University of Health Sciences Turkey, İzmir School of Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Onur Süneçli
- Department of Physiotherapy, University of Health Sciences Turkey, İzmir School of Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Cenk Kirakli
- Intensive Care Unit, University of Health Sciences Turkey, İzmir School of Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
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Collins PD, Giosa L, Camporota L, Barrett NA. State of the art: Monitoring of the respiratory system during veno-venous extracorporeal membrane oxygenation. Perfusion 2024; 39:7-30. [PMID: 38131204 DOI: 10.1177/02676591231210461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Monitoring the patient receiving veno-venous extracorporeal membrane oxygenation (VV ECMO) is challenging due to the complex physiological interplay between native and membrane lung. Understanding these interactions is essential to understand the utility and limitations of different approaches to respiratory monitoring during ECMO. We present a summary of the underlying physiology of native and membrane lung gas exchange and describe different tools for titrating and monitoring gas exchange during ECMO. However, the most important role of VV ECMO in severe respiratory failure is as a means of avoiding further ergotrauma. Although optimal respiratory management during ECMO has not been defined, over the last decade there have been advances in multimodal respiratory assessment which have the potential to guide care. We describe a combination of imaging, ventilator-derived or invasive lung mechanic assessments as a means to individualise management during ECMO.
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Affiliation(s)
- Patrick Duncan Collins
- Department of Critical Care Medicine, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Lorenzo Giosa
- Department of Critical Care Medicine, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Luigi Camporota
- Department of Critical Care Medicine, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Nicholas A Barrett
- Department of Critical Care Medicine, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK
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Brito R, Morais CCA, Lazo MT, Guiñez DV, Gajardo AIJ, Arellano DH, Amato MBP, Cornejo RA. Dynamic relative regional lung strain estimated by computed tomography and electrical impedance tomography in ARDS patients. Crit Care 2023; 27:457. [PMID: 38001485 PMCID: PMC10668403 DOI: 10.1186/s13054-023-04748-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND In the acute distress respiratory syndrome (ARDS), specific lung regions can be exposed to excessive strain due to heterogeneous disease, gravity-dependent lung collapse and injurious mechanical ventilation. Computed tomography (CT) is the gold standard for regional strain assessment. An alternative tool could be the electrical impedance tomography (EIT). We aimed to determine whether EIT-based methods can predict the dynamic relative regional strain (DRRS) between two levels of end-expiratory pressure (PEEP) in gravity-non-dependent and dependent lung regions. METHODS Fourteen ARDS patients underwent CT and EIT acquisitions (at end-inspiratory and end-expiratory) at two levels of PEEP: a low-PEEP based on ARDS-net strategy and a high-PEEP titrated according to EIT. Three EIT-based methods for DRRS were compared to relative CT-based strain: (1) the change of the ratio between EIT ventilation and end-expiratory lung impedance in arbitrary units ([ΔZAU low-PEEP/EELIAU low-PEEP]/[ΔZAU high-PEEP/EELIAU high-PEEP]), (2) the change of ΔZ/EELI ratio calibrated to mL ([ΔZml low-PEEP/EELIml low-PEEP]/[ΔZml high-PEEP/EELIml high-PEEP]) using CT data, and (3) the relative change of ∆ZAU (∆ZAU low-PEEP/∆ZAU high-PEEP). We performed linear regressions analysis and calculated bias and limits of agreement to assess the performance of DRRS by EIT in comparison with CT. RESULTS The DRRS assessed by (ΔZml low-PEEP/EELIml low-PEEP)/(ΔZml high-PEEP/EELIml high-PEEP) and ∆ZAU low-PEEP/∆ZAU high-PEEP showed good relationship and agreement with the CT method (R2 of 0.9050 and 0.8679, respectively, in non-dependent region; R2 of 0.8373 and 0.6588, respectively, in dependent region; biases ranging from - 0.11 to 0.51 and limits of agreement ranging from - 0.73 to 1.16 for both methods and lung regions). Conversely, DRRS based on EELIAU ([ΔZAU low-PEEP/EELIAU low-PEEP]/[ΔZAU high-PEEP/EELIAU high-PEEP]) exhibited a weak negative relationship and poor agreement with the CT method for both non-dependent and dependent regions (R2 ~ 0.3; bias of 3.11 and 2.08, and limits of agreement of - 2.13 to 8.34 and from - 1.49 to 5.64, respectively). CONCLUSION Changes in DRRS during a PEEP trial in ARDS patients could be monitored using EIT, based on changes in ΔZmL/EELIml and ∆ZAU. The relative change ∆ZAU offers the advantage of not requiring CT data for calibration.
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Affiliation(s)
- Roberto Brito
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Santiago, Chile
| | - Caio C A Morais
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Brazil
| | - Marioli T Lazo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Santiago, Chile
| | - Dannette V Guiñez
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Santiago, Chile
| | - Abraham I J Gajardo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Santiago, Chile
- Programa de Fisiopatología, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
| | - Daniel H Arellano
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Santiago, Chile
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Marcelo B P Amato
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo A Cornejo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Santiago, Chile.
- Center of Acute Respiratory Critical Illness (ARCI), Santiago, Chile.
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Heines SJH, Becher TH, van der Horst ICC, Bergmans DCJJ. Clinical Applicability of Electrical Impedance Tomography in Patient-Tailored Ventilation: A Narrative Review. Tomography 2023; 9:1903-1932. [PMID: 37888742 PMCID: PMC10611090 DOI: 10.3390/tomography9050150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Electrical Impedance Tomography (EIT) is a non-invasive bedside imaging technique that provides real-time lung ventilation information on critically ill patients. EIT can potentially become a valuable tool for optimising mechanical ventilation, especially in patients with acute respiratory distress syndrome (ARDS). In addition, EIT has been shown to improve the understanding of ventilation distribution and lung aeration, which can help tailor ventilatory strategies according to patient needs. Evidence from critically ill patients shows that EIT can reduce the duration of mechanical ventilation and prevent lung injury due to overdistension or collapse. EIT can also identify the presence of lung collapse or recruitment during a recruitment manoeuvre, which may guide further therapy. Despite its potential benefits, EIT has not yet been widely used in clinical practice. This may, in part, be due to the challenges associated with its implementation, including the need for specialised equipment and trained personnel and further validation of its usefulness in clinical settings. Nevertheless, ongoing research focuses on improving mechanical ventilation and clinical outcomes in critically ill patients.
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Affiliation(s)
- Serge J. H. Heines
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (I.C.C.v.d.H.); (D.C.J.J.B.)
| | - Tobias H. Becher
- Department of Anesthesiology and Intensive Care Medicine, Campus Kiel, University Medical Centre Schleswig-Holstein, 24118 Kiel, Germany;
| | - Iwan C. C. van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (I.C.C.v.d.H.); (D.C.J.J.B.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Dennis C. J. J. Bergmans
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (I.C.C.v.d.H.); (D.C.J.J.B.)
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands
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Ribeiro De Santis Santiago R, Xin Y, Gaulton TG, Alcala G, León Bueno de Camargo ED, Cereda M, Britto Passos Amato M, Berra L. Lung Imaging Acquisition with Electrical Impedance Tomography: Tackling Common Pitfalls. Anesthesiology 2023; 139:329-341. [PMID: 37402247 DOI: 10.1097/aln.0000000000004613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Electrical impedance tomography is a powerful tool for lung imaging that can be employed at the bedside in multiple clinical scenarios. Diagnosing and preventing interpretation pitfalls will ensure reliable data and allow for appropriate clinical decision-making.
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Affiliation(s)
- Roberta Ribeiro De Santis Santiago
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yi Xin
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy G Gaulton
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Glasiele Alcala
- Pulmonary Division, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Erick Dario León Bueno de Camargo
- Federal University of ABC/Engineering, Modeling and Applied Social Sciences Centre, Biomedical Engineering, São Bernardo do Campo, Brazil
| | - Maurizio Cereda
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Liu W, Yu K, Xiao L, Gao D, Liu X, Cao Y, Lin X, Liu L, Miao H, Li T. Effects of Electrical Impedance Tomography-Guided Positive End-Expiratory Pressure on Postoperative Cardiopulmonary Exercise Capacity in Elderly Patients: Study Protocol for a Randomized Controlled Trial. Med Sci Monit 2023; 29:e938333. [PMID: 36617749 PMCID: PMC9838052 DOI: 10.12659/msm.938333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mechanical ventilation can lead to cardiopulmonary complications in elderly patients undergoing abdominal surgery plus general anesthesia. The cardiopulmonary exercise test (CPET) is a dynamic and noninvasive evaluation method for assessing the cardiopulmonary system function under rest and stress. Positive end-expiratory pressure (PEEP) titration guided by electrical impedance tomography (EIT) can individualize lung protection strategies and may be beneficial in postoperative cardiopulmonary exercise capacity for these patients. MATERIAL AND METHODS This study is a prospective, single-center, randomized, and controlled trail that will include 80 elderly patients scheduled for major abdominal surgery. The patients will be divided into 2 groups: (1) intervention group: using individualized PEEP ventilation; and (2) control group: using fixed PEEP ventilation (3-5 cmH₂O). RESULTS The primary outcome is the change of postoperative cardiopulmonary exercise capacity. CONCLUSIONS In this study, we will evaluate if EIT-guided PEEP titration can improve postoperative cardiopulmonary exercise capacity and reduce postoperative complications in elderly patients undergoing open abdominal surgery plus general anesthesia. If the result is in accordance with the hypothesis, it would provide evidence to aid the perioperative management for these patients.
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Affiliation(s)
- Wentao Liu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Kang Yu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Li Xiao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Danyang Gao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Xiao Liu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Ying Cao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Xiaowan Lin
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Lei Liu
- Department of Science and Technology, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Huihui Miao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
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11
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Nascimento MS, Rebello CM, Costa ELV, Corrêa LC, Alcala GC, Rossi FS, Morais CCA, Laurenti E, Camara MC, Iasi M, Apezzato MLP, do Prado C, Amato MBP. Effect of general anesthesia and controlled mechanical ventilation on pulmonary ventilation distribution assessed by electrical impedance tomography in healthy children. PLoS One 2023; 18:e0283039. [PMID: 36928465 PMCID: PMC10019725 DOI: 10.1371/journal.pone.0283039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION General anesthesia is associated with the development of atelectasis, which may affect lung ventilation. Electrical impedance tomography (EIT) is a noninvasive imaging tool that allows monitoring in real time the topographical changes in aeration and ventilation. OBJECTIVE To evaluate the pattern of distribution of pulmonary ventilation through EIT before and after anesthesia induction in pediatric patients without lung disease undergoing nonthoracic surgery. METHODS This was a prospective observational study including healthy children younger than 5 years who underwent nonthoracic surgery. Monitoring was performed continuously before and throughout the surgical period. Data analysis was divided into 5 periods: induction (spontaneous breathing, SB), ventilation-5min, ventilation-30min, ventilation-late and recovery-SB. In addition to demographic data, mechanical ventilation parameters were also collected. Ventilation impedance (Delta Z) and pulmonary ventilation distribution were analyzed cycle by cycle at the 5 periods. RESULTS Twenty patients were included, and redistribution of ventilation from the posterior to the anterior region was observed with the beginning of mechanical ventilation: on average, the percentage ventilation distribution in the dorsal region decreased from 54%(IC95%:49-60%) to 49%(IC95%:44-54%). With the restoration of spontaneous breathing, ventilation in the posterior region was restored. CONCLUSION There were significant pulmonary changes observed during anesthesia and controlled mechanical ventilation in children younger than 5 years, mirroring the findings previously described adults. Monitoring these changes may contribute to guiding the individualized settings of the mechanical ventilator with the goal to prevent postoperative complications.
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Affiliation(s)
- Milena S. Nascimento
- Departamento Materno-Infantil, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Divisão de Pneumologia, Departamento de Cardiologia–Instituto do Coração (INCOR) Hospital das Clínicas, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- * E-mail:
| | - Celso M. Rebello
- Departamento Materno-Infantil, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Eduardo L. V. Costa
- Divisão de Pneumologia, Departamento de Cardiologia–Instituto do Coração (INCOR) Hospital das Clínicas, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Instituto de Ensino e Pesquisa—Hospital Sírio Libanês, São Paulo, São Paulo, Brazil
| | | | | | - Felipe S. Rossi
- Departamento Materno-Infantil, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Developer Division, Timpel SA, São Paulo, São Paulo, Brazil
| | - Caio C. A. Morais
- Divisão de Pneumologia, Departamento de Cardiologia–Instituto do Coração (INCOR) Hospital das Clínicas, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eliana Laurenti
- Departamento Centro Cirúrgico, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Mauro C. Camara
- Departamento Centro Cirúrgico, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Marcelo Iasi
- Departamento Centro Cirúrgico, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Maria L. P. Apezzato
- Departamento Centro Cirúrgico, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Cristiane do Prado
- Departamento Materno-Infantil, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Marcelo B. P. Amato
- Divisão de Pneumologia, Departamento de Cardiologia–Instituto do Coração (INCOR) Hospital das Clínicas, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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12
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Zhou C, Chase JG. Low-cost structured light imaging of regional volume changes for use in assessing mechanical ventilation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107176. [PMID: 36228494 DOI: 10.1016/j.cmpb.2022.107176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/21/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Optimal setting of mechanical ventilators is critical for improving outcomes. Accurate, predictive lung mechanics models are effective in optimizing MV settings, but only at a global level as they cannot estimate regional lung volume ventilation to assess the potential of local distension or under-ventilation. This study presents a low-cost structured light system for non-contact high resolution chest motion measurement to estimate regional lung volume changes. METHODS The system consists of a structured light projector and two cameras. A new pattern is designed to extract motion from sub-regions of the chest surface, and an efficient feature is proposed to provide a fast and accurate correspondence matching between two views. Reconstruction of 3D surface points is based on the matched points and stereo method. Asymmetric distribution of tidal volume into left and right lungs is estimated based on reconstructed regional chest expansion. A proof-of-concept experiment using a dummy model and two test lungs connected to a ventilator to provide differential chest expansion is conducted under tidal volumes of 400 ml, 500 ml and 600 ml, with results compared to the widely-used SURF and ORB methods. RESULTS Compared to the SURF and ORB methods, the proposed method is more computationally efficient with ∼40% less computational time cost, and higher accuracy for dense point correspondence. Finally, the proposed method estimated the region lung volumes with the maximum error of 8 ml under 600 ml tidal volume, indicating a good accuracy. CONCLUSIONS Surface reconstruction results in a proof-of-concept experiment with differential chest expansion show good performance for the proposed pattern and method in extracting the key information for regional chest expansion. The proposed method is generalizable, with potential for use in other applications.
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Affiliation(s)
- Cong Zhou
- School of Civil Aviation, Northwestern Polytechnical University, China; Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand
| | - J Geoffrey Chase
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand.
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13
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Physiological benefits of lung recruitment in the semi-lateral position after laparoscopic surgery: a randomized controlled study. Sci Rep 2022; 12:3909. [PMID: 35273175 PMCID: PMC8913840 DOI: 10.1038/s41598-022-04841-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022] Open
Abstract
We evaluated the physiological benefits of performing lung recruitment maneuver (LRM) in the semi-lateral position compared in the supine position. Seventy-nine patients undergoing laparoscopic prostatectomy were randomly assigned to either the supine or semi-lateral group according to body position during the LRM. At the end of surgery, LRM (35 cmH2O for 20 s) was performed twice in the assigned posture. The primary outcome was the maximal decrease in systolic arterial pressure during LRM. Secondary outcomes were changes in PaO2/FiO2 and the regional lung volume distribution after LRM. The decrease in systolic arterial pressure during the LRM was significantly higher in the supine group than in the semi-lateral group (mean ± standard deviation, [-] 27.6 ± 14.6% vs. [-] 18.6 ± 9.9%, P = 0.001). Improvement in PaO2/FiO2 ratio after the LRM was evident in both groups but was more prominent in the semi-lateral group than in the supine group (median [interquartile range], 39.3% [20.2, 63.6] vs. 18.2% [8.4, 29.2], P = 0.001). Among the horizontal lung divisions, regional lung volume in the most dependent portion (the dorsal division) was significantly increased after the LRM only in the semi-lateral group (P = 0.024). Performing lung recruitment in a semi-lateral position protected against hemodynamic deterioration during the LRM and increased regional lung ventilation in the dependent portion of the lung, leading to an improvement in arterial oxygenation after laparoscopic procedures.Trial registration Clinical Research Information Service ( https://cris.nih.go.kr/ ). Identifier: KCT0003756.
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14
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Effects of PEEP on the relationship between tidal volume and total impedance change measured via electrical impedance tomography (EIT). J Clin Monit Comput 2022; 36:325-334. [PMID: 33492490 PMCID: PMC7829490 DOI: 10.1007/s10877-021-00651-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/06/2021] [Indexed: 01/31/2023]
Abstract
Electrical impedance tomography (EIT) is used in lung physiology monitoring. There is evidence that EIT is linearly associated with global tidal volume (VT) in clinically healthy patients where no positive end-expiratory pressure (PEEP) is applied. This linearity has not been challenged by altering lung conditions. The aim of this study was to determine the effect of PEEP on VT estimation, using EIT technology and spirometry, and observe the stability of the relationship under changing lung conditions. Twelve male castrated cattle (Steer), mean age 7.8 months (SD ± 1.7) were premedicated with xylazine followed by anaesthesia induction with ketamine and maintenance with halothane in oxygen via an endotracheal tube. An EIT belt was applied around the thorax at the level of the fifth intercostal space. Volume controlled ventilation was used. PEEP was increased in a stepwise manner from 0 to 5, 10 and 15 cmH2O. At each PEEP, the VT was increased stepwise from 5 to 10 and 15 mL kg-1. After a minute of stabilisation, total impedance change (VTEIT), using EIT and VT measured by a spirometer connected to a flow-partitioning device (VTSpiro) was recorded for the following minute before changing ventilator settings. Data was analysed using linear regression and multi variable analysis. There was a linear relationship between VTEIT and VTSpiro at all levels of PEEP with an R2 of 0.71, 0.68, 0.63 and 0.63 at 0, 5, 10 and 15 cmH2O, respectively. The variance in VTEIT was best described by peak inspiratory pressure (PIP) and PEEP (adjusted R2 0.82) while variance in VTSpiro was best described by PIP and airway deadspace (adjusted R2 0.76). The relationship between VTEIT and VTSpiro remains linear with changes in tidal volume, and stable across altered lung conditions. This may have application for monitoring and assessment in vivo.
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15
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Song X, Yang D, Yang M, Bai Y, Qin B, Tian S, Song G, Guo X, Dong R, Men Y, Liu Z, Liu X, Wang C. Effect of Electrical Impedance Tomography-Guided Early Mobilization in Patients After Major Upper Abdominal Surgery: Protocol for a Prospective Cohort Study. Front Med (Lausanne) 2021; 8:710463. [PMID: 34957133 PMCID: PMC8695759 DOI: 10.3389/fmed.2021.710463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pulmonary complications are common in patients after upper abdominal surgery, resulting in poor clinical outcomes and increased costs of hospitalization. Enhanced Recovery After Surgery Guidelines strongly recommend early mobilization post-operatively; however, the quality of the evidence is poor, and indicators for quantifying the effectiveness of early mobilization are lacking. This study will evaluate the effectiveness of early mobilization in patients undergoing an upper abdominal surgery using electrical impedance tomography (EIT). Specifically, we will use EIT to assess and compare the lung ventilation distribution among various regions of interest (ROI) before and after mobilization in this patient population. Additionally, we will assess the temporal differences in the distribution of ventilation in various ROI during mobilization in an effort to develop personalized activity programs for this patient population. Methods: In this prospective, single-center cohort study, we aim to recruit 50 patients after upper abdominal surgery between July 1, 2021 and June 30, 2022. This study will use EIT to quantify the ventilation distribution among different ROI. On post-operative day 1, the nurses will assist the patient to sit on the chair beside the bed. Patient's heart rate, blood pressure, oxygen saturation, respiratory rate, and ROI 1-4 will be recorded before the mobilization as baseline. These data will be recorded again at 15, 30, 60, 90, and 120 min after mobilization, and the changes in vital signs and ROI 1-4 values at each time point before and after mobilization will be compared. Ethics and Dissemination: The study protocol has been approved by the Institutional Review Board of Liaocheng Cardiac Hospital (2020036). The trial is registered at chictr.org.cn with identifier ChiCTR2100042877, registered on January 31, 2021. The results of the study will be presented at relevant national and international conferences and submitted to international peer-reviewed journals. There are no plans to communicate results specifically to participants. Important protocol modifications, such as changes to eligibility criteria, outcomes, or analyses, will be communicated to all relevant parties (including investigators, Institutional Review Board, trial participants, trial registries, journals, and regulators) as needed via email or in-person communication.
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Affiliation(s)
- Xuan Song
- Intensive Care Unit (ICU), Liaocheng Cardiac Hospital, Liaocheng, China.,Intensive Care Unit (ICU), Dong E Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Daqiang Yang
- Intensive Care Unit (ICU), Liaocheng Cardiac Hospital, Liaocheng, China.,Intensive Care Unit (ICU), Dong E Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Maopeng Yang
- Intensive Care Unit (ICU), Liaocheng Cardiac Hospital, Liaocheng, China.,Intensive Care Unit (ICU), Dong E Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Yahu Bai
- Intensive Care Unit (ICU), Liaocheng Cardiac Hospital, Liaocheng, China.,Intensive Care Unit (ICU), Dong E Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Bingxin Qin
- Intensive Care Unit (ICU), Liaocheng Cardiac Hospital, Liaocheng, China.,Intensive Care Unit (ICU), Dong E Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Shoucheng Tian
- Intensive Care Unit (ICU), Liaocheng Cardiac Hospital, Liaocheng, China.,Intensive Care Unit (ICU), Dong E Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Gangbing Song
- Intensive Care Unit (ICU), Liaocheng Cardiac Hospital, Liaocheng, China.,Intensive Care Unit (ICU), Dong E Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Xiuyan Guo
- Education Department, Dong E Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Ranran Dong
- Intensive Care Unit (ICU), Liaocheng Cardiac Hospital, Liaocheng, China.,Intensive Care Unit (ICU), Dong E Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Yuanyuan Men
- Intensive Care Unit (ICU), Liaocheng Cardiac Hospital, Liaocheng, China.,Intensive Care Unit (ICU), Dong E Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Ziwei Liu
- Internal Medicine, Qingdao University, Qingdao, China
| | - Xinyan Liu
- Intensive Care Unit (ICU), Liaocheng Cardiac Hospital, Liaocheng, China.,Intensive Care Unit (ICU), Dong E Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Chunting Wang
- Intensive Care Unit (ICU), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Liaocheng, China
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16
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Hochhausen N, Kapell T, Dürbaum M, Follmann A, Rossaint R, Czaplik M. Monitoring postoperative lung recovery using electrical impedance tomography in post anesthesia care unit: an observational study. J Clin Monit Comput 2021; 36:1205-1212. [PMID: 34542735 PMCID: PMC9294009 DOI: 10.1007/s10877-021-00754-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/29/2021] [Indexed: 11/26/2022]
Abstract
With electrical impedance tomography (EIT) recruitment and de-recruitment phenomena can be quantified and monitored at bedside. The aim was to examine the feasibility of EIT with respect to monitor atelectasis formation and resolution in the post anesthesia care unit (PACU). In this observational study, 107 postoperative patients were investigated regarding the presence and recovery of atelectasis described by the EIT-derived parameters Global Inhomogeneity Index (GI Index), tidal impedance variation (TIV), and the changes in end-expiratory lung impedance (ΔEELI). We examined whether the presence of obesity (ADP group) has an influence on pulmonary recovery compared to normal weight patients (NWP group). During the stay at PACU, measurements were taken every 15 min. GI Index, TIV, and ΔEELI were calculated for each time point. 107 patients were monitored and EIT-data of 16 patients were excluded for various reasons. EIT-data of 91 patients were analyzed off-line. Their length of stay averaged 80 min (25th and 75th quartile 52–112). The ADP group demonstrated a significantly higher GI Index at PACU arrival (p < 0.001). This finding disappeared during their stay at the PACU. Additionally, the ADP group showed a significant increase in ΔEELI between PACU arrival and discharge (p = 0.025). Furthermore, TIV showed a significantly lower value during the first 90 min of PACU stay as compared to the time period thereafter (p = 0.036). Our findings demonstrate that obesity has an influence on intraoperative atelectasis formation and de-recruitment during PACU stay. The application of EIT in spontaneously breathing PACU patients seems meaningful in monitoring pulmonary recovery.
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Affiliation(s)
- Nadine Hochhausen
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Torsten Kapell
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Martin Dürbaum
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Andreas Follmann
- Department of Anesthesiology, Medical Faculty, 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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17
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Spinelli E, Kircher M, Stender B, Ottaviani I, Basile MC, Marongiu I, Colussi G, Grasselli G, Pesenti A, Mauri T. Unmatched ventilation and perfusion measured by electrical impedance tomography predicts the outcome of ARDS. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:192. [PMID: 34082795 PMCID: PMC8173510 DOI: 10.1186/s13054-021-03615-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/21/2021] [Indexed: 12/30/2022]
Abstract
Background In acute respiratory distress syndrome (ARDS), non-ventilated perfused regions coexist with non-perfused ventilated regions within lungs. The number of unmatched regions might reflect ARDS severity and affect the risk of ventilation-induced lung injury. Despite pathophysiological relevance, unmatched ventilation and perfusion are not routinely assessed at the bedside. The aims of this study were to quantify unmatched ventilation and perfusion at the bedside by electrical impedance tomography (EIT) investigating their association with mortality in patients with ARDS and to explore the effects of positive end-expiratory pressure (PEEP) on unmatched ventilation and perfusion in subgroups of patients with different ARDS severity based on PaO2/FiO2 and compliance. Methods Prospective observational study in 50 patients with mild (36%), moderate (46%), and severe (18%) ARDS under clinical ventilation settings. EIT was applied to measure the regional distribution of ventilation and perfusion using central venous bolus of saline 5% during end-inspiratory pause. We defined unmatched units as the percentage of only ventilated units plus the percentage of only perfused units. Results Percentage of unmatched units was significantly higher in non-survivors compared to survivors (32[27–47]% vs. 21[17–27]%, p < 0.001). Percentage of unmatched units was an independent predictor of mortality (OR 1.22, 95% CI 1.07–1.39, p = 0.004) with an area under the ROC curve of 0.88 (95% CI 0.79–0.97, p < 0.001). The percentage of ventilation to the ventral region of the lung was higher than the percentage of ventilation to the dorsal region (32 [27–38]% vs. 18 [13–21]%, p < 0.001), while the opposite was true for perfusion (28 [22–38]% vs. 36 [32–44]%, p < 0.001). Higher percentage of only perfused units was correlated with lower dorsal ventilation (r = − 0.486, p < 0.001) and with lower PaO2/FiO2 ratio (r = − 0.293, p = 0.039). Conclusions EIT allows bedside assessment of unmatched ventilation and perfusion in mechanically ventilated patients with ARDS. Measurement of unmatched units could identify patients at higher risk of death and could guide personalized treatment.
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Affiliation(s)
- Elena Spinelli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Michael Kircher
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Irene Ottaviani
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Maria C Basile
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Ines Marongiu
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giulia Colussi
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, 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, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. .,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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18
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Sun XM, Chen GQ, Wang YM, Zhou YM, Chen JR, Cheng KM, Yang YL, Zhang LL, Li HL, Zhou JX. Derecruitment volume assessment derived from pressure-impedance curves with electrical impedance tomography in experimental acute lung injury. J Int Med Res 2021; 48:300060520949037. [PMID: 32816562 PMCID: PMC7444134 DOI: 10.1177/0300060520949037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective To investigate the accuracy of derecruitment volume (VDER) assessed by pressure–impedance (P-I) curves derived from electrical impedance tomography (EIT). Methods Six pigs with acute lung injury received decremental positive end-expiratory pressure (PEEP) from 15 to 0 in steps of 5 cmH2O. At the end of each PEEP level, the pressure–volume (P-V) curves were plotted using the low constant flow method and release maneuvers to calculate the VDER between the PEEP of setting levels and 0 cmH2O (VDER-PV). The VDER derived from P-I curves that were recorded simultaneously using EIT was the difference in impedance at the same pressure multiplied by the ratio of tidal volume and corresponding tidal impedance (VDER-PI). The regional P-I curves obtained by EIT were used to estimate VDER in the dependent and nondependent lung. Results The global lung VDER-PV and VDER-PI showed close correlations (r = 0.948, P<0.001); the mean difference was 48 mL with limits of agreement of −133 to 229 mL. Lung derecruitment extended into the whole process of decremental PEEP levels but was unevenly distributed in different lung regions. Conclusions P-I curves derived from EIT can assess VDER and provide a promising method to estimate regional lung derecruitment at the bedside.
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Affiliation(s)
- Xiu-Mei Sun
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guang-Qiang Chen
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Mei Wang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Min Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing-Ran Chen
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kun-Ming Cheng
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan-Lin Yang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin-Lin Zhang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong-Liang Li
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Xin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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19
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Electrical Tomography Reconstruction Using Reconfigurable Waveforms in a FPGA. SENSORS 2021; 21:s21093272. [PMID: 34068457 PMCID: PMC8125997 DOI: 10.3390/s21093272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022]
Abstract
The principal objective of this research is to conceive a mobile system based on electrical tomography for subsurface imaging and monitoring in order to enable simultaneous recording of electrical potentials of cardiac and pulmonary activity. For an exploration of excitation waveforms in electrical tomography, specialized hardware is required. As the main principle of tomography is the measurement of electrical perturbations on an unknown object, it is crucial to synchronize excitation and sensing processes in a very precise way for the purpose of acquiring meaningful data. To cope with this problem, an FPGA device is used, with an architecture that allows us to trigger excitation signals and to read sensed data simultaneously via independent processes that share the same clock. In this way, waveform reconfiguration on frequency and shape can be provided and studied. The system is connected to a standard microcontroller SoC with a simple API that allows for IoT capabilities for on-line operation and tracking, given that the design is targeted for in vivo medical monitoring. As a result of the research work, a measuring device was developed, the surface data analyzed and the image was reconstructed using the selected configuration.
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20
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Martinsson A, Houltz E, Wallinder A, Lindgren S, Thorén A. Lung recruitment in the prone position after cardiac surgery: a randomised controlled study. Br J Anaesth 2021; 126:1067-1074. [PMID: 33602580 DOI: 10.1016/j.bja.2020.12.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Atelectasis after cardiac surgery is common and promotes ventilation/perfusion mismatch, infection, and delayed discharge from critical care. Recruitment manoeuvres are often performed to reduce atelectasis. In severe respiratory failure, recruitment manoeuvres in the prone position may increase oxygenation, survival, or both. We compared the effects of recruitment manoeuvres in the prone vs supine position on lung aeration and oxygenation in cardiac surgical patients. METHODS Subjects were randomised to recruitment manoeuvres (40 cm H2O peak inspiratory pressure and 20 cm H2O PEEP for 30 s) in either the prone or supine position after uncomplicated cardiac surgery. The co-primary endpoints were lung aeration (end-expiratory lung volume measured by electrical impedance tomography (arbitrary units [a.u.]) and lung oxygenation (ratio of arterial oxygen partial pressure to fractional inspired oxygen [Pao2/FiO2 ratio]). Secondary outcomes included postoperative oxygen requirement and adverse events. RESULTS Thirty subjects (27% female; age, 48-81 yr) were recruited. Dorsal lung tidal volume was higher after prone recruitment manoeuvres (363 a.u.; 95% confidence intervals [CI], 283-443; n=15) after extubation, compared with supine recruitment manoeuvres (212 a.u.; 95% CI, 170-254; n=15; P<0.001). Prone recruitment manoeuvres increased dorsal end-expiratory lung volume by 724 a.u. (95% CI, 456-992) after extubation, compared with 163 a.u. decrease (95% CI, 73-252) after supine recruitment manoeuvres (P<0.001). The Pao2/FiO2 ratio after extubation was higher after prone recruitment manoeuvres (46.6; 95% CI, 40.7-53.0) compared with supine recruitment manoeuvres (39.3; 95% CI, 34.8-43.8; P=0.04). Oxygen therapy after extubation was shorter after prone (33 h [13]) vs supine recruitment manoeuvres (52 h [22]; P=0.01). No adverse events occurred. CONCLUSIONS Recruitment manoeuvres in the prone position after cardiac surgery improve lung aeration and oxygenation. CLINICAL TRIAL REGISTRATION NCT03009331.
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Affiliation(s)
- Andreas Martinsson
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erik Houltz
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Wallinder
- Department of Cardiothoracic Surgery, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sophie Lindgren
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Thorén
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
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21
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Tran MC, Crockett DC, Cronin JN, Borges JB, Hedenstierna G, Larsson A, Farmery AD, Formenti F. Bedside monitoring of lung volume available for gas exchange. Intensive Care Med Exp 2021; 9:3. [PMID: 33496887 PMCID: PMC7835652 DOI: 10.1186/s40635-020-00364-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/02/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Bedside measurement of lung volume may provide guidance in the personalised setting of respiratory support, especially in patients with the acute respiratory distress syndrome at risk of ventilator-induced lung injury. We propose here a novel operator-independent technique, enabled by a fibre optic oxygen sensor, to quantify the lung volume available for gas exchange. We hypothesised that the continuous measurement of arterial partial pressure of oxygen (PaO2) decline during a breath-holding manoeuvre could be used to estimate lung volume in a single-compartment physiological model of the respiratory system. METHODS Thirteen pigs with a saline lavage lung injury model and six control pigs were studied under general anaesthesia during mechanical ventilation. Lung volumes were measured by simultaneous PaO2 rate of decline (VPaO2) and whole-lung computed tomography scan (VCT) during apnoea at different positive end-expiratory and end-inspiratory pressures. RESULTS A total of 146 volume measurements was completed (range 134 to 1869 mL). A linear correlation between VCT and VPaO2 was found both in control (slope = 0.9, R2 = 0.88) and in saline-lavaged pigs (slope = 0.64, R2 = 0.70). The bias from Bland-Altman analysis for the agreement between the VCT and VPaO2 was - 84 mL (limits of agreement ± 301 mL) in control and + 2 mL (LoA ± 406 mL) in saline-lavaged pigs. The concordance for changes in lung volume, quantified with polar plot analysis, was - 4º (LoA ± 19°) in control and - 9° (LoA ± 33°) in saline-lavaged pigs. CONCLUSION Bedside measurement of PaO2 rate of decline during apnoea is a potential approach for estimation of lung volume changes associated with different levels of airway pressure.
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Affiliation(s)
- Minh C Tran
- Nuffield Division of Anaesthetics, University of Oxford, Oxford, UK.
- Department of Engineering Science, University of Oxford, Oxford, UK.
| | | | - John N Cronin
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
- Department of Anaesthetics, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - João Batista Borges
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Göran Hedenstierna
- Hedenstierna Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andrew D Farmery
- Nuffield Division of Anaesthetics, University of Oxford, Oxford, UK
| | - Federico Formenti
- Nuffield Division of Anaesthetics, University of Oxford, Oxford, UK.
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK.
- Department of Biomechanics, University of Nebraska, Omaha, NE, USA.
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22
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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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23
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Franchineau G, Bréchot N, Hekimian G, Lebreton G, Bourcier S, Demondion P, Le Guennec L, Nieszkowska A, Luyt CE, Combes A, Schmidt M. Prone positioning monitored by electrical impedance tomography in patients with severe acute respiratory distress syndrome on veno-venous ECMO. Ann Intensive Care 2020; 10:12. [PMID: 32016593 PMCID: PMC6997307 DOI: 10.1186/s13613-020-0633-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/24/2020] [Indexed: 12/25/2022] Open
Abstract
Background Prone positioning (PP) during veno-venous ECMO is feasible, but its physiological effects have never been thoroughly evaluated. Our objectives were to describe, through electrical impedance tomography (EIT), the impact of PP on global and regional ventilation, and optimal PEEP level. Methods A monocentric study conducted on ECMO-supported severe ARDS patients, ventilated in pressure-controlled mode, with 14-cmH2O driving pressure and EIT-based “optimal PEEP”. Before, during and after a 16-h PP session, EIT-based distribution and variation of tidal impedance, VTdorsal/VTglobal ratio, end-expiratory lung impedance (EELI) and static compliance were collected. Subgroup analyses were performed in patients who increased their static compliance by ≥ 3 mL/cmH2O after 16 h of PP. Results For all patients (n = 21), tidal volume and EELI were redistributed from ventral to dorsal regions during PP. EIT-based optimal PEEP was significantly lower in PP than in supine position. Median (IQR) optimal PEEP decreased from 14 (12–16) to 10 (8–14) cmH2O. Thirteen (62%) patients increased their static compliance by ≥ 3 mL/cmH2O after PP on ECMO. This subgroup had higher body mass index, more frequent viral pneumonia, shorter ECMO duration, and lower baseline VTdorsal/VTglobal ratio than patients with compliance ≤ 3 mL/cmH2O (P < 0.01). Conclusion Although baseline tidal volume distribution on EIT may predict static compliance improvement after PP on ECMO, our results support physiological benefits of PP in all ECMO patients, by modifying lung mechanics and potentially reducing VILI. Further studies, including a randomized–controlled trial, are now warranted to confirm potential PP benefits during ECMO.
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Affiliation(s)
- Guillaume Franchineau
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, UPMC Univ Paris 06, 75651, Paris Cedex 13, France.,Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
| | - Nicolas Bréchot
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, UPMC Univ Paris 06, 75651, Paris Cedex 13, France.,Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
| | - Guillaume Hekimian
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, UPMC Univ Paris 06, 75651, Paris Cedex 13, France.,Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
| | - Guillaume Lebreton
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, UPMC Univ Paris 06, 75651, Paris Cedex 13, France.,Cardiac Surgery Department, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
| | - Simon Bourcier
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, UPMC Univ Paris 06, 75651, Paris Cedex 13, France.,Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
| | - Pierre Demondion
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, UPMC Univ Paris 06, 75651, Paris Cedex 13, France.,Cardiac Surgery Department, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
| | - Loïc Le Guennec
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, UPMC Univ Paris 06, 75651, Paris Cedex 13, France.,Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
| | - Ania Nieszkowska
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, UPMC Univ Paris 06, 75651, Paris Cedex 13, France.,Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
| | - Charles-Edouard Luyt
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, UPMC Univ Paris 06, 75651, Paris Cedex 13, France.,Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
| | - Alain Combes
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, UPMC Univ Paris 06, 75651, Paris Cedex 13, France.,Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
| | - Matthieu Schmidt
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, UPMC Univ Paris 06, 75651, Paris Cedex 13, France. .,Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France.
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24
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Electrical Impedance Tomography for Cardio-Pulmonary Monitoring. J Clin Med 2019; 8:jcm8081176. [PMID: 31394721 PMCID: PMC6722958 DOI: 10.3390/jcm8081176] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 12/14/2022] Open
Abstract
Electrical impedance tomography (EIT) is a bedside monitoring tool that noninvasively visualizes local ventilation and arguably lung perfusion distribution. This article reviews and discusses both methodological and clinical aspects of thoracic EIT. Initially, investigators addressed the validation of EIT to measure regional ventilation. Current studies focus mainly on its clinical applications to quantify lung collapse, tidal recruitment, and lung overdistension to titrate positive end-expiratory pressure (PEEP) and tidal volume. In addition, EIT may help to detect pneumothorax. Recent studies evaluated EIT as a tool to measure regional lung perfusion. Indicator-free EIT measurements might be sufficient to continuously measure cardiac stroke volume. The use of a contrast agent such as saline might be required to assess regional lung perfusion. As a result, EIT-based monitoring of regional ventilation and lung perfusion may visualize local ventilation and perfusion matching, which can be helpful in the treatment of patients with acute respiratory distress syndrome (ARDS).
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25
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Mauri T, Spinelli E, Dalla Corte F, Scotti E, Turrini C, Lazzeri M, Alban L, Albanese M, Tortolani D, Wang YM, Spadaro S, Zhou JX, Pesenti A, Grasselli G. Noninvasive assessment of airflows by electrical impedance tomography in intubated hypoxemic patients: an exploratory study. Ann Intensive Care 2019; 9:83. [PMID: 31332551 PMCID: PMC6646434 DOI: 10.1186/s13613-019-0560-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/17/2019] [Indexed: 11/05/2022] Open
Abstract
Background Noninvasive monitoring of maximal inspiratory and expiratory flows (MIF and MEF, respectively) by electrical impedance tomography (EIT) might enable early recognition of changes in the mechanical properties of the respiratory system due to new conditions or in response to treatments. We aimed to validate EIT-based measures of MIF and MEF against spirometry in intubated hypoxemic patients during controlled ventilation and spontaneous breathing. Moreover, regional distribution of maximal airflows might interact with lung pathology and increase the risk of additional ventilation injury. Thus, we also aimed to describe the effects of mechanical ventilation settings on regional MIF and MEF. Methods We performed a new analysis of data from two prospective, randomized, crossover studies. We included intubated patients admitted to the intensive care unit with acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) undergoing pressure support ventilation (PSV, n = 10) and volume-controlled ventilation (VCV, n = 20). We measured MIF and MEF by spirometry and EIT during six different combinations of ventilation settings: higher vs. lower support during PSV and higher vs. lower positive end-expiratory pressure (PEEP) during both PSV and VCV. Regional airflows were assessed by EIT in dependent and non-dependent lung regions, too. Results MIF and MEF measured by EIT were tightly correlated with those measured by spirometry during all conditions (range of R2 0.629–0.776 and R2 0.606–0.772, respectively, p < 0.05 for all), with clinically acceptable limits of agreement. Higher PEEP significantly improved homogeneity in the regional distribution of MIF and MEF during volume-controlled ventilation, by increasing airflows in the dependent lung regions and lowering them in the non-dependent ones. Conclusions EIT provides accurate noninvasive monitoring of MIF and MEF. The present study also generates the hypothesis that EIT could guide PSV and PEEP settings aimed to increase homogeneity of distending and deflating regional airflows. Electronic supplementary material The online version of this article (10.1186/s13613-019-0560-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- 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 Transplantation, University of Milan, Milan, Italy.
| | - Elena Spinelli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Francesca Dalla Corte
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Eleonora Scotti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Cecilia Turrini
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Marta Lazzeri
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Laura Alban
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Marco Albanese
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Donatella Tortolani
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Yu-Mei Wang
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.,Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Jian-Xin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - 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 Transplantation, University of Milan, Milan, 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 Transplantation, University of Milan, Milan, Italy
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Araos JD, Lacitignola L, Stripoli T, Grasso S, Crovace A, Staffieri F. Effects of positive end-expiratory pressure alone or an open-lung approach on recruited lung volumes and respiratory mechanics of mechanically ventilated horses. Vet Anaesth Analg 2019; 46:780-788. [PMID: 31477474 DOI: 10.1016/j.vaa.2019.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 03/29/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the effects of positive end-expiratory pressure (PEEP) alone and PEEP preceded by lung recruitment manoeuvre (LRM) on lung volumes and respiratory system mechanics in healthy horses undergoing general anaesthesia. STUDY DESIGN Controlled, prospective clinical study. ANIMALS A group of 15 horses undergoing arthroscopy. METHODS Following anaesthetic induction, initial ventilatory settings were: tidal volume 15 mL kg-1, inspiratory:expiratory ratio 1:2, respiratory rate to maintain end-tidal CO2 between 5.3-6.6 kPa (40-50 mmHg). The following settings were implemented sequentially: zero PEEP (ZEEP); PEEP 10 cmH2O (PEEP); LRM (50 cmH2O for 20 seconds) followed by 10 cmH2O of PEEP (LRM + PEEP). Static compliance (Cst), driving pressure, delta end-expiratory (ΔEELV) and recruited lung volumes (RLV) were obtained 30 minutes after initiating each ventilatory strategy. Data were analyzed with paired t test or analysis of variance followed by Tukey's post hoc test. Data are shown as mean ± standard deviation; p < 0.05 was considered significant. RESULTS PEEP induced ΔEELV of 6.68 ± 3.36 mL kg-1; ΔEELV during LRM + PEEP was 14.28 ± 5.59 mL kg-1 (p < 0.0001). The RLV was greater during the LRM + PEEP phase (12.30 ± 5.85 mL kg-1) than during PEEP (4.47 ± 3.97 mL kg-1; p < 0.0001). The Cst was unchanged from ZEEP to PEEP (0.75 ± 0.21 and 0.85 ± 0.22 mL cmH2O-1 kg-1, respectively, p = 0.36) but increased using LRM + PEEP (1.11 ± 0.25 mL cmH2O-1 kg-1, p = 0.0004). Driving pressure was lower during LRM + PEEP than during PEEP and ZEEP (16 ± 2, 19 ± 2 and 21 ± 4 cmH2O, respectively, p < 0.0001). CONCLUSIONS AND CLINICAL RELEVANCE Unlike PEEP alone, PEEP preceded by LRM increased RLV and Cst and reduced driving pressure in horses under anaesthesia.
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Affiliation(s)
- Joaquin D Araos
- Centre Hospitalier Universitaire Veterinaire, Faculte de Medecine Veterinaire, Universite de Montreal, Québec, Canada
| | - Luca Lacitignola
- Surgery Unit, Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| | - Tania Stripoli
- Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation (D.E.O.T.), "Aldo Moro" University of Bari, Bari, Italy
| | - Salvatore Grasso
- Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation (D.E.O.T.), "Aldo Moro" University of Bari, Bari, Italy
| | - Antonio Crovace
- Surgery Unit, Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| | - Francesco Staffieri
- Surgery Unit, Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy.
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Sosio S, Bellani G, Villa S, Lupieri E, Mauri T, Foti G. A Calibration Technique for the Estimation of Lung Volumes in Nonintubated Subjects by Electrical Impedance Tomography. Respiration 2019; 98:189-197. [PMID: 31195395 DOI: 10.1159/000499159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 02/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Electrical impedance tomography (EIT) is a bedside monitoring technique of the respiratory system that measures impedance changes within the thorax. The close correlation between variations in impedance (ΔZ) and lung volumes (Vt) is known. Unless Vt is measured by an external reference (e.g., spirometry), its absolute value (in milliliters) cannot be determined; however, measurement of Vt would be useful in nonintubated subjects. OBJECTIVE To validate a simplified and feasible calibration method of EIT, which allows estimation of Vt in nonintubated subjects. MATERIALS AND METHODS We performed a prospective study on 13 healthy volunteers. Subjects breathed 10 times in a nonexpandable "calibration balloon" with a known volume while wearing the EIT belt. The relationship between ΔZ and the balloon volume was calculated (ΔZ/Vt). Subsequently, subjects were connected to a mechanical ventilator by a mouthpiece under different settings. Vt was calculated from EIT measurements (VtEIT) by means of the ΔZ/Vt coefficient and compared with the value obtained from the ventilator (Vtflow). RESULTS There was a close correlation between Vtflow and VtEIT (r2 = 0.89). The fit equation was VtEIT = 0.9 × Vtflow +10.1. The highest correlation was found at positive endexpiratory pressure (PEEP) 0 (mean: VtEIT = 0.93 × Vtflow) versus PEEP 8 (mean: VtEIT = 0.8 × Vtflow), p = 0.01. No differences in the fit equation were found between pressure support ventilation (PSV) 0 and PSV 8, p = 0.50. Further analysis showed no statistically significant differences between sex, height, and BMI. CONCLUSION A simple and fast EIT calibration technique enables reliable, noninvasive monitoring of Vt in nonintubated subjects.
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Affiliation(s)
- Simone Sosio
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Giacomo Bellani
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy, .,Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy,
| | - Silvia Villa
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Ermes Lupieri
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care, and Emergency, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giuseppe Foti
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.,Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
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Sobota V, Müller M, Roubík K. Intravenous administration of normal saline may be misinterpreted as a change of end-expiratory lung volume when using electrical impedance tomography. Sci Rep 2019; 9:5775. [PMID: 30962469 PMCID: PMC6453964 DOI: 10.1038/s41598-019-42241-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/26/2019] [Indexed: 11/30/2022] Open
Abstract
Electrical impedance tomography (EIT) is a noninvasive imaging modality that allows real-time monitoring of regional lung ventilation. The aim of the study is to investigate whether fast saline infusion causes changes in lung impedance that could affect the interpretation of EIT data. Eleven pigs were anaesthetized and mechanically ventilated. A bolus of 500 mL of normal saline was administered rapidly. Two PEEP steps were performed to allow quantification of the effect of normal saline on lung impedance. The mean change of end-expiratory lung impedance (EELI) caused by the saline bolus was equivalent to a virtual decrease of end-expiratory lung volume (EELV) by 227 (188–250) mL and decremental PEEP step of 4.40 (3.95–4.59) cmH2O (median and interquartile range). In contrast to the changes of PEEP, the administration of normal saline did not cause any significant differences in measured EELV, regional distribution of lung ventilation determined by EIT or in extravascular lung water and intrathoracic blood volume. In conclusion, EELI can be affected by the changes of EELV as well as by the administration of normal saline. These two phenomena can be distinguished by analysis of regional distribution of lung ventilation.
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Affiliation(s)
- Vladimír Sobota
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic. .,Department of Physiology, Maastricht University, Maastricht, The Netherlands.
| | - Martin Müller
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic.,Department of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Karel Roubík
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
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Fulton R, Millar JE, Merza M, Johnston H, Corley A, Faulke D, Rapchuk I, Tarpey J, Lockie P, Lockie S, Fraser JF. High flow nasal oxygen after bariatric surgery (OXYBAR), prophylactic post-operative high flow nasal oxygen versus conventional oxygen therapy in obese patients undergoing bariatric surgery: study protocol for a randomised controlled pilot trial. Trials 2018; 19:402. [PMID: 30053897 PMCID: PMC6062994 DOI: 10.1186/s13063-018-2777-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/29/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The incidence of obesity is increasing worldwide. In selected individuals, bariatric surgery may offer a means of achieving long-term weight loss, improved health, and healthcare cost reduction. Physiological changes that occur because of obesity and general anaesthesia predispose to respiratory complications following bariatric surgery. The aim of this study is to determine whether post-operative high flow nasal oxygen therapy (HFNO2) improves respiratory function and reduces the incidence of post-operative pulmonary complications (PPCs) in comparison to conventional oxygen therapy in these patients. METHOD The OXYBAR study is a prospective, un-blinded, single centre, randomised, controlled pilot study. Patients with body mass index (BMI) > 30 kg/m2, undergoing laparoscopic bariatric surgery, will be randomised to receive either standard low flow oxygen therapy or HFNO2 in the post-operative period. The primary outcome measure is the change in end expiratory lung impedance (∆EELI) as measured by electrical impedance tomography (EIT). Secondary outcome measures include change in tidal volume (∆Vt), partial arterial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, incidence of PPCs, hospital length of stay and measures of patient comfort. DISCUSSION We hypothesise that the post-operative administration of HFNO2 will increase EELI and therefore end expiratory lung volume (EELV) in obese patients. To our knowledge this is the first trial designed to assess the effects of HFNO2 on EELV in this population. We anticipate that data collected during this pilot study will inform a larger multicentre trial. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617000694314 . Registered on 15 May 2017.
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Affiliation(s)
- Rachel Fulton
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
| | - Jonathan E. Millar
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Wellcome-Wolfson Centre for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland UK
| | - Megan Merza
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
- St Andrews War Memorial Hospital, Brisbane, Australia
| | | | - Amanda Corley
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
- Griffith University, Griffith, Queensland Australia
| | - Daniel Faulke
- St Andrews War Memorial Hospital, Brisbane, Australia
| | - Ivan Rapchuk
- St Andrews War Memorial Hospital, Brisbane, Australia
| | - Joe Tarpey
- St Andrews War Memorial Hospital, Brisbane, Australia
| | - Philip Lockie
- St Andrews War Memorial Hospital, Brisbane, Australia
| | | | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Heines SJH, Strauch U, van de Poll MCG, Roekaerts PMHJ, Bergmans DCJJ. Clinical implementation of electric impedance tomography in the treatment of ARDS: a single centre experience. J Clin Monit Comput 2018; 33:291-300. [PMID: 29845479 PMCID: PMC6420412 DOI: 10.1007/s10877-018-0164-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/27/2018] [Indexed: 11/24/2022]
Abstract
To report on our clinical experience using EIT in individualized PEEP titration in ARDS. Using EIT assessment, we optimized PEEP settings in 39 ARDS patients. The EIT PEEP settings were compared with the physicians' PEEP settings and the PEEP settings according to the ARDS network. We defined a PEEP difference equal to or greater than 4 cm H2O as clinically relevant. Changes in lung compliance and PaO2/FiO2-ratio were compared in patients with EIT-based PEEP adjustments and in patients with unaltered PEEP. In 28% of the patients, the difference in EIT-based PEEP and physician-PEEP was clinically relevant; in 36%, EIT-based PEEP and physician-PEEP were equal. The EIT-based PEEP disagreed with the PEEP settings according to the ARDS network. Adjusting PEEP based upon EIT led to a rapid increase in lung compliance and PaO2/FiO2-ratio. However, this increase was also observed in the group where the PEEP difference was less than 4 cm H2O. We hypothesize that this can be attributed to the alveolar recruitment during the PEEP trial. EIT based individual PEEP setting appears to be a promising method to optimize PEEP in ARDS patients. The clinical impact, however, remains to be established.
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Affiliation(s)
- Serge J H Heines
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6229HX, Maastricht, The Netherlands.
| | - Ulrich Strauch
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6229HX, Maastricht, The Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6229HX, Maastricht, The Netherlands.,Department of Surgery, Maastricht University Medical Centre+, P. Debyelaan 25, 6229HX, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Medicine (NUTRIM), Maastricht University, P.O. Box 616, 6200MD, Maastricht, The Netherlands
| | - Paul M H J Roekaerts
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6229HX, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200MD, Maastricht, The Netherlands
| | - Dennis C J J Bergmans
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6229HX, Maastricht, The Netherlands
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Meira C, Joerger FB, Kutter AP, Waldmann A, Ringer SK, Böehm SH, Iff S, Mosing M. Comparison of three continuous positive airway pressure (CPAP) interfaces in healthy Beagle dogs during medetomidine–propofol constant rate infusions. Vet Anaesth Analg 2018; 45:145-157. [DOI: 10.1016/j.vaa.2017.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
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Lobo B, Hermosa C, Abella A, Gordo F. Electrical impedance tomography. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:26. [PMID: 29430443 PMCID: PMC5799136 DOI: 10.21037/atm.2017.12.06] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/30/2017] [Indexed: 11/06/2022]
Abstract
Continuous assessment of respiratory status is one of the cornerstones of modern intensive care unit (ICU) monitoring systems. Electrical impedance tomography (EIT), although with some constraints, may play the lead as a new diagnostic and guiding tool for an adequate optimization of mechanical ventilation in critically ill patients. EIT may assist in defining mechanical ventilation settings, assess distribution of tidal volume and of end-expiratory lung volume (EELV) and contribute to titrate positive end-expiratory pressure (PEEP)/tidal volume combinations. It may also quantify gains (recruitment) and losses (overdistention or derecruitment), granting a more realistic evaluation of different ventilator modes or recruitment maneuvers, and helping in the identification of responders and non-responders to such maneuvers. Moreover, EIT also contributes to the management of life-threatening lung diseases such as pneumothorax, and aids in guiding fluid management in the critical care setting. Lastly, assessment of cardiac function and lung perfusion through electrical impedance is on the way.
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Affiliation(s)
- Beatriz Lobo
- Intensive Care Unit, Henares University Hospital, Coslada-Madrid, Spain
- Grupo de Investigación en Patología Crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Cecilia Hermosa
- Intensive Care Unit, Henares University Hospital, Coslada-Madrid, Spain
- Grupo de Investigación en Patología Crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Ana Abella
- Intensive Care Unit, Henares University Hospital, Coslada-Madrid, Spain
- Grupo de Investigación en Patología Crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Federico Gordo
- Intensive Care Unit, Henares University Hospital, Coslada-Madrid, Spain
- Grupo de Investigación en Patología Crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
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Hao Z, Yue S, Sun B, Wang H. Optimal distance of multi-plane sensor in three-dimensional electrical impedance tomography. Comput Assist Surg (Abingdon) 2017; 22:326-338. [DOI: 10.1080/24699322.2017.1389412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Zhenhua Hao
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Shihong Yue
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Benyuan Sun
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Huaxiang Wang
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
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Abstract
The main goals of assessing respiratory system mechanical function are to evaluate the lung function through a variety of methods and to detect early signs of abnormalities that could affect the patient's outcomes. In ventilated patients, it has become increasingly important to recognize whether respiratory function has improved or deteriorated, whether the ventilator settings match the patient's demand, and whether the selection of ventilator parameters follows a lung-protective strategy. Ventilator graphics, esophageal pressure, intra-abdominal pressure, and electric impedance tomography are some of the best-known monitoring tools to obtain measurements and adequately evaluate the respiratory system mechanical function.
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Franchineau G, Bréchot N, Lebreton G, Hekimian G, Nieszkowska A, Trouillet JL, Leprince P, Chastre J, Luyt CE, Combes A, Schmidt M. Bedside Contribution of Electrical Impedance Tomography to Setting Positive End-Expiratory Pressure for Extracorporeal Membrane Oxygenation–treated Patients with Severe Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2017; 196:447-457. [DOI: 10.1164/rccm.201605-1055oc] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Guillaume Franchineau
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Université Pierre et Marie Curie Univ Paris 06, Paris, France; and
- Medical Intensive Care Unit and
| | - Nicolas Bréchot
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Université Pierre et Marie Curie Univ Paris 06, Paris, France; and
- Medical Intensive Care Unit and
| | - Guillaume Lebreton
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Université Pierre et Marie Curie Univ Paris 06, Paris, France; and
- Cardiac Surgery Department, Assistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière Hospital, Paris, France
| | - Guillaume Hekimian
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Université Pierre et Marie Curie Univ Paris 06, Paris, France; and
- Medical Intensive Care Unit and
| | - Ania Nieszkowska
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Université Pierre et Marie Curie Univ Paris 06, Paris, France; and
- Medical Intensive Care Unit and
| | - Jean-Louis Trouillet
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Université Pierre et Marie Curie Univ Paris 06, Paris, France; and
- Medical Intensive Care Unit and
| | - Pascal Leprince
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Université Pierre et Marie Curie Univ Paris 06, Paris, France; and
- Cardiac Surgery Department, Assistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière Hospital, Paris, France
| | - Jean Chastre
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Université Pierre et Marie Curie Univ Paris 06, Paris, France; and
- Medical Intensive Care Unit and
| | - Charles-Edouard Luyt
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Université Pierre et Marie Curie Univ Paris 06, Paris, France; and
- Medical Intensive Care Unit and
| | - Alain Combes
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Université Pierre et Marie Curie Univ Paris 06, Paris, France; and
- Medical Intensive Care Unit and
| | - Matthieu Schmidt
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Université Pierre et Marie Curie Univ Paris 06, Paris, France; and
- Medical Intensive Care Unit and
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Santos SA, Wembers CC, Horst K, Pfeifer R, Simon TP, Pape HC, Hildebrand F, Czaplik M, Leonhardt S, Teichmann D. Monitoring lung contusion in a porcine polytrauma model using EIT: an application study. Physiol Meas 2017. [DOI: 10.1088/1361-6579/aa7985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Caruana LR, Barnett AG, Tronstad O, Paratz JD, Chang AT, Fraser JF. Global tidal variations, regional distribution of ventilation, and the regional onset of filling determined by electrical impedance tomography: reproducibility. Anaesth Intensive Care 2017; 45:235-243. [PMID: 28267946 DOI: 10.1177/0310057x1704500214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The reproducibility of the regional distribution of ventilation and the timing of onset of regional filling as measured by electrical impedance tomography lacks evidence. This study investigated whether electrical impedance tomography measurements in healthy males were reproducible when electrodes were replaced between measurements. Part 1: Recordings of five volunteers lying supine were made using electrical impedance tomography and a pneumotachometer. Measurements were repeated at least three hours later. Skin marking ensured accurate replacement of electrodes. No stabilisation period was allowed. Part 2: Electrical impedance tomography recordings of ten volunteers; a 15 minute stabilisation period, extra skin markings, and time-averaging were incorporated to improve the reproducibility. Reproducibility was determined using the Bland-Altman method. To judge the transferability of the limits of agreement, a Pearson correlation was used for electrical impedance tomography tidal variation and tidal volume. Tidal variation was judged to be reproducible due to the significant correlation between tidal variation and tidal volume (r2 = 0.93). The ventilation distribution was not reproducible. A stabilisation period, extra skin markings and time-averaging did not improve the outcome. The timing of regional onset of filling was reproducible and could prove clinically valuable. The reproducibility of the tidal variation indicates that non-reproducibility of the ventilation distribution was probably a biological difference and not measurement error. Other causes of variability such as electrode placement variability or lack of stabilisation when accounted for did not improve the reproducibility of the ventilation distribution.
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Affiliation(s)
- L R Caruana
- Physiotherapist, The Critical Care Research Group, The Prince Charles Hospital, The University of Queensland School of Medicine, Brisbane, Queensland
| | - A G Barnett
- Associate Professor, The Critical Care Research Group, The Prince Charles Hospital, School of Public Health & Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland
| | - O Tronstad
- Clinical Lead Physiotherapist, The Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland
| | - J D Paratz
- Physiotherapist, The Critical Care Research Group, The Prince Charles Hospital, Burns, Trauma and Critical Research Centre, School of Medicine, University of Queensland, Brisbane, Griffith University, Southport, Queensland
| | - A T Chang
- Physiotherapist, The Critical Care Research Group, The Prince Charles Hospital, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland
| | - J F Fraser
- Director, The Critical Care Research Group, The Prince Charles Hospital, Professor, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland
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Wilsterman MEF, de Jager P, Blokpoel R, Frerichs I, Dijkstra SK, Albers MJIJ, Burgerhof JGM, Markhorst DG, Kneyber MCJ. Short-term effects of neuromuscular blockade on global and regional lung mechanics, oxygenation and ventilation in pediatric acute hypoxemic respiratory failure. Ann Intensive Care 2016; 6:103. [PMID: 27783382 PMCID: PMC5081313 DOI: 10.1186/s13613-016-0206-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/17/2016] [Indexed: 01/10/2023] Open
Abstract
Background Neuromuscular blockade (NMB) has been shown to improve outcome in acute respiratory distress syndrome (ARDS) in adults, challenging maintaining spontaneous breathing when there is severe lung injury. We tested in a prospective physiological study the hypothesis that continuous administration of NMB agents in mechanically ventilated children with severe acute hypoxemic respiratory failure (AHRF) improves the oxygenation index without a redistribution of tidal volume VT toward non-dependent lung zones. Methods Oxygenation index, PaO2/FiO2 ratio, lung mechanics (plateau pressure, mean airway pressure, respiratory system compliance and resistance), hemodynamics (heart rate, central venous and arterial blood pressures), oxygenation [oxygenation index (OI), PaO2/FiO2 and SpO2/FiO2], ventilation (physiological dead space-to-VT ratio) and electrical impedance tomography measured changes in end-expiratory lung volume (EELV), and VT distribution was measured before and 15 min after the start of continuous infusion of rocuronium 1 mg/kg. Patients were ventilated in a time-cycled, pressure-limited mode with pre-set VT. All ventilator settings were not changed during the study. Results Twenty-two patients were studied (N = 18 met the criteria for pediatric ARDS). Median age (25–75 interquartile range) was 15 (7.8–77.5) weeks. Pulmonary pathology was present in 77.3%. The median lung injury score was 9 (8–10). The overall median CoV and regional lung filling characteristics were not affected by NMB, indicating no ventilation shift toward the non-dependent lung zones. Regional analysis showed a homogeneous time course of lung inflation during inspiration, indicating no tendency to atelectasis after the introduction of NMB. NMB decreased the mean airway pressure (p = 0.039) and OI (p = 0.039) in all patients. There were no significant changes in lung mechanics, hemodynamics and EELV. Subgroup analysis showed that OI decreased (p = 0.01) and PaO2/FiO2 increased (p = 0.02) in patients with moderate or severe PARDS. Conclusions NMB resulted in an improved oxygenation index in pediatric patients with AHRF. Distribution of VT and regional lung filling characteristics were not affected.
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Affiliation(s)
- Marlon E F Wilsterman
- Division of Paediatric Intensive Care, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Paediatrics, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - Pauline de Jager
- Division of Paediatric Intensive Care, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Robert Blokpoel
- Division of Paediatric Intensive Care, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Inez Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sandra K Dijkstra
- Division of Paediatric Intensive Care, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Marcel J I J Albers
- Division of Paediatric Intensive Care, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dick G Markhorst
- Division of Paediatric Intensive Care, Department of Paediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin C J Kneyber
- Division of Paediatric Intensive Care, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. .,Critical Care, Anaesthesia, Peri-operative Medicine and Emergency Medicine (CAPE), University of Groningen, Groningen, The Netherlands.
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End-Expiratory Lung Volume in Patients with Acute Respiratory Distress Syndrome: A Time Course Analysis. Lung 2016; 194:527-34. [PMID: 27169535 DOI: 10.1007/s00408-016-9892-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Lung injury can be caused by ventilation and non-physiological lung stress (transpulmonary pressure) and strain [inflated volume over functional residual capacity ratio (FRC)]. FRC is severely decreased in patients with acute respiratory distress syndrome (ARDS). End-expiratory lung volume (EELV) is FRC plus lung volume increased by the applied positive end-expiratory pressure (PEEP). Measurement using the modified nitrogen multiple breath washout technique may help titrating PEEP during ARDS and allow determining dynamic lung strain (tidal volume over EELV) in patients ventilated with PEEP. In this observational study, we measured EELV for up to seven consecutive days in patients with ARDS at different PEEP levels. RESULTS Thirty sedated patients with ARDS (10 mild, 14 moderate, 6 severe) underwent decremental PEEP testing (20, 15, 10, 5 cm H2O) for up to 7 days after inclusion. At all PEEP levels examined, over a period of 7 days the measured absolute EELVs showed no significant change over time [PEEP 20 cm H2O 2464 ml at day 1 vs. 2144 ml at day 7 (p = 0.78), PEEP 15 cm H2O 2226 ml vs. 1990 ml (p = 0.36), PEEP 10 1835 ml vs. 1858 ml (p = 0.76) and PEEP 5 cm H2O 1487 ml vs. 1612 ml (p = 0.37)]. In relation to the predicted body weight (pbw), no significant change in EELV/kg pbw over time could be detected either at any PEEP level or over time [PEEP 20 36 ml/kg pbw at day 1 vs. 33 ml/kg pbw at day 7 (p = 0.66); PEEP 15 33 vs. 29 ml/kg pbw (p = 0.32); PEEP 10 27 vs. 27 ml/kg pbw (p = 0.70) and PEEP 5 22 vs. 24 ml/kg pbw (p = 0.70)]. Oxygenation significantly improved over time from PaO2/FiO2 of 169 mmHg at day 1 to 199 mmHg at day 7 (p < 0.01). CONCLUSIONS EELV did not change significantly for up to 7 days in patients with ARDS. By contrast, PaO2/FiO2 improved significantly. Bedside measurement of EELV may be a novel approach to individualise lung-protective ventilation on the basis of calculation of dynamic strain as the ratio of VT to EELV.
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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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Sutt AL, Caruana LR, Dunster KR, Cornwell PL, Anstey CM, Fraser JF. Speaking valves in tracheostomised ICU patients weaning off mechanical ventilation--do they facilitate lung recruitment? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:91. [PMID: 27038617 PMCID: PMC4818462 DOI: 10.1186/s13054-016-1249-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 02/19/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients who require positive pressure ventilation through a tracheostomy are unable to phonate due to the inflated tracheostomy cuff. Whilst a speaking valve (SV) can be used on a tracheostomy tube, its use in ventilated ICU patients has been inhibited by concerns regarding potential deleterious effects to recovering lungs. The objective of this study was to assess end expiratory lung impedance (EELI) and standard bedside respiratory parameters before, during and after SV use in tracheostomised patients weaning from mechanical ventilation. METHODS A prospective observational study was conducted in a cardio-thoracic adult ICU. 20 consecutive tracheostomised patients weaning from mechanical ventilation and using a SV were recruited. Electrical Impedance Tomography (EIT) was used to monitor patients' EELI. Changes in lung impedance and standard bedside respiratory data were analysed pre, during and post SV use. RESULTS Use of in-line SVs resulted in significant increase of EELI. This effect grew and was maintained for at least 15 minutes after removal of the SV (p < 0.001). EtCO2 showed a significant drop during SV use (p = 0.01) whilst SpO2 remained unchanged. Respiratory rate (RR (breaths per minute)) decreased whilst the SV was in situ (p <0.001), and heart rate (HR (beats per minute)) was unchanged. All results were similar regardless of the patients' respiratory requirements at time of recruitment. CONCLUSIONS In this cohort of critically ill ventilated patients, SVs did not cause derecruitment of the lungs when used in the ventilator weaning period. Deflating the tracheostomy cuff and restoring the airflow via the upper airway with a one-way valve may facilitate lung recruitment during and after SV use, as indicated by increased EELI. TRIAL REGISTRATION Anna-Liisa Sutt, Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN ACTRN12615000589583. 4/6/2015.
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Affiliation(s)
- Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia. .,School of Medicine, University of Queensland, Brisbane, Australia. .,Speech Pathology Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Lawrence R Caruana
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
| | - Kimble R Dunster
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Science & Engineering Faculty, Queensland University of Technology, Brisbane, Australia
| | - Petrea L Cornwell
- Allied Health Collaborative, Metro North HHS, Brisbane, Australia.,School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Chris M Anstey
- School of Medicine, University of Queensland, Brisbane, Australia.,Critical Care Research Group, Sunshine Coast University Hospital, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
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Karsten J, Stueber T, Voigt N, Teschner E, Heinze H. Influence of different electrode belt positions on electrical impedance tomography imaging of regional ventilation: a prospective observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:3. [PMID: 26743570 PMCID: PMC4705633 DOI: 10.1186/s13054-015-1161-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 12/04/2015] [Indexed: 12/03/2022]
Abstract
Background Electrical impedance tomography (EIT) is a non-invasive bedside tool which allows an individualized ventilator strategy by monitoring tidal ventilation and lung aeration. EIT can be performed at different cranio-caudal thoracic levels, but data are missing about the optimal belt position. The main goal of this prospective observational study was to evaluate the impact of different electrode layers on tidal impedance variation in relation to global volume changes in order to propose a proper belt position for EIT measurements. Methods EIT measurements were performed in 15 mechanically ventilated intensive care patients with the electrode belt at different thoracic layers (L1-L7). All respiratory and hemodynamic parameters were recorded. Blood gas analyses were obtained once at the beginning of EIT examination. Off-line tidal impedance variation/tidal volume (TV/VT) ratio was calculated, and specific patterns of impedance distribution due to automatic and user-defined adjustment of the colour scale for EIT images were identified. Results TV/VT ratio is the highest at L1. It decreases in caudal direction. At L5, the decrease of TV/VT ratio is significant. We could identify patterns of diaphragmatic interference with ventilation-related impedance changes, which owing to the automatically adjusted colour scales are not obvious in the regularly displayed EIT images. Conclusions The clinical usability and plausibility of EIT measurements depend on proper belt position, proper impedance visualisation, correct analysis and data interpretation. When EIT is used to estimate global parameters like VT or changes in end-expiratory lung volume, the best electrode plane is between the 4th and 5th intercostal space. The specific colour coding occasionally suppresses user-relevant information, and manual rescaling of images is necessary to visualise this information.
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Affiliation(s)
- Jan Karsten
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Thomas Stueber
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Nicolas Voigt
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Eckhard Teschner
- Draeger Medical GmbH, Moislinger Allee 53, 23558, Lübeck, Germany.
| | - Hermann Heinze
- Department of Anaesthesiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Abstract
PURPOSE OF REVIEW Measurements of lung volumes allow evaluating the pathophysiogical severity of acute respiratory distress syndrome (ARDS) in terms of the degree of reduction in aerated lung volume, calculating strain, quantifying recruitment and/or hyperinflation, and gas volume distribution. We summarize the current techniques for lung volume assessment selected according to their possible usage in the ICU and discuss the recent findings obtained with implementation of these techniques in patients with ARDS. RECENT FINDINGS Computed tomography technique remains irreplaceable in terms of quantitative aeration of different lung regions, but the commonly used cut-offs for classification may be questioned with recent findings on nonpathological lungs. Monitoring end expiratory lung volume using nitrogen washout technique enhanced our understanding on lung volume change during positioning, pleural effusion drainage, intra-abdominal hypertension, and recruitment maneuver. Recent studies supported that tidal volume could not surrogate tidal strain, which needs measurement of functional residual capacity and which is correlated with pro-inflammatory lung response. SUMMARY Although lung volume measurements are still limited to research area of ARDS, recent progress in technology provides clinicians more opportunities to evaluate lung volumes noninvasively at the bedside and may facilitate individualization of ventilator settings based on the specific physiological understandings of a given patient.
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Electrical impedance tomography-guided prone positioning in a patient with acute cor pulmonale associated with severe acute respiratory distress syndrome. J Anesth 2015; 30:161-5. [PMID: 26446805 PMCID: PMC4744250 DOI: 10.1007/s00540-015-2084-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 09/20/2015] [Indexed: 01/12/2023]
Abstract
Electrical impedance tomography (EIT) is a noninvasive technique used to assess regional gas distribution in the lung. We experienced a patient with acute cor pulmonale during high positive-pressure ventilation for the treatment of severe acute respiratory distress syndrome. Prone positioning was beneficial for unloading the right ventricle for treatment of acute cor pulmonale. EIT played a role in detecting lung derecruitment at the patient’s bedside. Impedance distribution in ventral, mid-ventral, mid-dorsal, and dorsal layers before and 20 min after the start of prone positioning was 9, 48, 44, and 0 %, and 10, 25, 48, and 16 %, respectively. Lung recruitment monitored by EIT paralleled the improvement of PaO2/FIO2 from 123 to 239 mmHg. Timing of termination of prone positioning and ventilator settings such as lowering positive end-expiration pressure was determined to maintain dorsal recruitment as seen by EIT. The patient was weaned from mechanical ventilation on day 32 and discharged on day 200. EIT assessed the effects of prone positioning with real-time dynamic imaging and guided less injurious mechanical ventilation in a patient with acute cor pulmonale with dorsal lung derecruitment.
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Nebuya S, Koike T, Imai H, Iwashita Y, Brown BH, Soma K. Feasibility of using ‘lung density’ values estimated from EIT images for clinical diagnosis of lung abnormalities in mechanically ventilated ICU patients. Physiol Meas 2015; 36:1261-71. [DOI: 10.1088/0967-3334/36/6/1261] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Krueger-Ziolek S, Schullcke B, Kretschmer J, Müller-Lisse U, Möller K, Zhao Z. Positioning of electrode plane systematically influences EIT imaging. Physiol Meas 2015; 36:1109-18. [DOI: 10.1088/0967-3334/36/6/1109] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hsu CF, Cheng JS, Lin WC, Ko YF, Cheng KS, Lin SH, Chen CW. Electrical impedance tomography monitoring in acute respiratory distress syndrome patients with mechanical ventilation during prolonged positive end-expiratory pressure adjustments. J Formos Med Assoc 2015; 115:195-202. [PMID: 25843526 DOI: 10.1016/j.jfma.2015.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/23/2015] [Accepted: 03/02/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND/PURPOSE The time required to reach oxygenation equilibrium after positive end-expiratory pressure (PEEP) adjustments in mechanically ventilated patients with acute respiratory distress syndrome (ARDS) is unclear. We used electrical impedance tomography to elucidate gas distribution and factors related to oxygenation status following PEEP in patients with ARDS. METHODS Nineteen mechanically ventilated ARDS patients were placed on baseline PEEP (PEEPB) for 1 hour, PEEPB - 4 cmH2O PEEP (PEEPL) for 30 minutes, and PEEPB + 4 cmH2O PEEP (PEEPH) for 1 hour. Tidal volume and respiratory rate were similar. Impedance changes, respiratory parameters, and arterial blood gases were measured at baseline, 5 minutes, and 30 minutes after PEEPL, and 5 minutes, 15 minutes, 30 minutes, and 1 hour after PEEPH. RESULTS PaO2/fraction of inspired oxygen (P/F ratio) decreased quickly from PEEPB to PEEPL, and stabilized 5 minutes after PEEPL. However the P/F ratio progressively increased from PEEPL to PEEPH, and a significantly higher P/F ratio and end-expiratory lung impedance were found at 60 minutes compared to 5 minutes after PEEPH. The end-expiratory lung impedance level significantly correlated with P/F ratio (p < 0.001). With increasing PEEP, dorsal ventilation significantly increased; however, regional ventilation did not change over time with PEEP level. CONCLUSION Late improvements in oxygenation following PEEP escalation are probably due to slow recruitment in ventilated ARDS patients. Electrical impedance tomography may be an appropriate tool to assess recruitment and oxygenation status in patients with changes in PEEP.
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Affiliation(s)
- Chia-Fu Hsu
- Medical Intensive Care Unit, Department of Internal Medicine, National Cheng Kung University Affiliated Hospital, Tainan, Taiwan
| | - Jen-Suo Cheng
- Medical Intensive Care Unit, Department of Internal Medicine, National Cheng Kung University Affiliated Hospital, Tainan, Taiwan
| | - Wei-Chi Lin
- Medical Intensive Care Unit, Department of Internal Medicine, National Cheng Kung University Affiliated Hospital, Tainan, Taiwan
| | - Yen-Fen Ko
- Bioengineering Institute, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Sheng Cheng
- Bioengineering Institute, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chang-Wen Chen
- Medical Intensive Care Unit, Department of Internal Medicine, National Cheng Kung University Affiliated Hospital, Tainan, Taiwan; Medical Device Innovation Center, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
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Pfurtscheller K, Ring S, Beran E, Sorantin E, Zobel J, Ganster D, Avian A, Zobel G. Effect of body position on ventilation distribution during PEEP titration in a porcine model of acute lung injury using advanced respiratory monitoring and electrical impedance tomography. Intensive Care Med Exp 2015. [PMID: 26215805 PMCID: PMC4513029 DOI: 10.1186/s40635-014-0038-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Lung failure after acute lung injury remains a challenge in different clinical settings. Various interventions for restoration of gas exchange have been investigated. Recruitment of collapsed alveoli by positive end expiratory pressure (PEEP) titration and optimization of ventilation-perfusion ratio by prone positioning have been extensively described in animal and clinical trials. This animal study was conducted to investigate the effects of PEEP and positioning by means of advanced respiratory monitoring including gas exchange, respiratory mechanics, volumetric capnography and electrical impedance tomography. Methods After induction of acute lung injury by oleic acid and lung lavage, 12 domestic pigs were studied in randomly assigned supine or prone position during a PEEP titration trial with maximal PEEP of 30 mbar. Results Induction of lung injury resulted in significant deterioration of oxygenation [partial pressure of arterial oxygen/inspiratory fraction of oxygen (PaO2/FiO2): p = 0.002] and ventilation [partial pressure of arterial carbon dioxide (PaCO2): p = 0.002] and elevated alveolar dead-space ratios (Valv/Vte: p = 0.003) in both groups. Differences in the prone and the supine group were significant for PaCO2 at incremental PEEP 10 and 20 and at decremental PEEP 20 (20d) and 10 (10d), for PaO2/FiO2 at PEEP 10 and 10d and for alveolar dead space at PEEP 10d. Electrical impedance tomography revealed homogenous ventilation distribution in prone position during PEEP 20, 30 and 20d. Conclusions Prone position leads to improved oxygenation and ventilation parameters in a lung injury model. Respiratory monitoring with measurement of alveolar dead space and electrical impedance tomography may visualize optimized ventilation in a PEEP titration trial.
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Affiliation(s)
- Klaus Pfurtscheller
- Pediatric Intensive Care Unit, University Children's Hospital and Medical University Graz, Auenbruggerplatz 34, 8036, Graz, Austria,
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Monitoring of regional lung ventilation using electrical impedance tomography after cardiac surgery in infants and children. Pediatr Cardiol 2014; 35:990-7. [PMID: 24569885 DOI: 10.1007/s00246-014-0886-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/06/2014] [Indexed: 02/05/2023]
Abstract
Electrical impedance tomography (EIT) is a noninvasive method to monitor regional lung ventilation in infants and children without using radiation. The objective of this prospective study was to determine the value of EIT as an additional monitoring tool to assess regional lung ventilation after pediatric cardiac surgery for congenital heart disease in infants and children. EIT monitoring was performed in a prospective study comprising 30 pediatric patients who were mechanically ventilated after cardiac surgery. Data were analyzed off-line with respect to regional lung ventilation in different clinical situations. EIT data were correlated with respirator settings and arterial carbon dioxide (CO2) partial pressure in the blood. In 29 of 30 patients, regional ventilation of the lung could sufficiently and reliably be monitored by means of EIT. The effects of the transition from mechanical ventilation to spontaneous breathing after extubation on regional lung ventilation were studied. After extubation, a significant decrease of relative impedance changes was evident. In addition, a negative correlation of arterial CO2 partial pressure and relative impedance changes could be shown. EIT was sufficient to discriminate differences of regional lung ventilation in children and adolescents after cardiac surgery. EIT reliably provided additional information on regional lung ventilation in children after cardiac surgery. Neither chest tubes nor pacemaker wires nor the intensive care unit environment interfered with the application of EIT. EIT therefore may be used as an additional real-time monitoring tool in pediatric cardiac intensive care because it is noninvasive.
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Cross-Sectional Changes in Lung Volume Measured by Electrical Impedance Tomography Are Representative for the Whole Lung in Ventilated Preterm Infants. Crit Care Med 2014; 42:1524-30. [DOI: 10.1097/ccm.0000000000000230] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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