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Jiang H, Li Q, Yu X, Zhang C, Li Y, Niu G, Tong ZH, Xi JN, Zhao Z. Ventilation improvement after pneumonia treatment evaluated with electrical impedance tomography: an observational study. Physiol Meas 2021; 42. [PMID: 33971628 DOI: 10.1088/1361-6579/abffbf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/10/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Due to radiation exposures, not all patients with pneumonia would receive chest x-ray or CT measurements to confirm treatment effectiveness. The aim of the study was to examine the ability of using electrical impedance tomography (EIT) to evaluate the treatment effectiveness in such patient group. METHODS A total of 35 consecutive patients with non-severe pneumonia was included in this prospective study. The patients received standard treatment according to our internal protocol. EIT measurements were performed in supine position before the treatment start and on day 6 of the treatment period. EIT-based global inhomogeneity (GI) index and center of ventilation index (CoV) were calculated. Clinical pulmonary infection score (CPIS) was obtained at both time points. RESULTS Clinically significant improvements in GI and CoV were found in patient group (ΔGI: -34%±17% and ΔCoV: -10%±11%; p<0.001). Although CPIS was also significantly improved (ΔCPIS -0.70±0.17, p<0.001), no correlations were demonstrated when it compared to ΔGI or ΔCoV. CONCLUSION EIT demonstrated individual improvement of ventilation heterogeneity after standard treatment in non-severe pneumonia, which provided different information compared to CPIS. EIT has the potential to become a routine non-invasive, non-radiative tool to assess pneumonia treatment effectiveness.
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Affiliation(s)
- Hongying Jiang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing, Beijing, CHINA
| | - Qing Li
- Department of Respiratory Rehabilitation Centre, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, CHINA
| | - Xin Yu
- Department of Respiratory Rehabilitation Centre, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, CHINA
| | - Chenxi Zhang
- Department of Respiratory Rehabilitation Centre, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, CHINA
| | - Yi Li
- Department of Respiratory Rehabilitation Centre, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, CHINA
| | - Guangyu Niu
- Department of Respiratory Rehabilitation Centre, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, CHINA
| | - Zhao-Hui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing, Beijing, CHINA
| | - Jia-Ning Xi
- Department of Respiratory Rehabilitation Centre, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, CHINA
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, 710032, CHINA
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Yang L, Dai M, Cao X, Möller K, Dargvainis M, Frerichs I, Becher T, Fu F, Zhao Z. Regional ventilation distribution in healthy lungs: can reference values be established for electrical impedance tomography parameters? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:789. [PMID: 34268402 PMCID: PMC8246208 DOI: 10.21037/atm-20-7442] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/24/2021] [Indexed: 12/26/2022]
Abstract
Background Although electrical impedance tomography (EIT) is widely used for monitoring regional ventilation distribution, reference values have yet to be established for clinical use. The present study aimed to evaluate the feasibility of creating reference values for standard EIT parameters for potential clinical application. Methods A total of 75 participants with healthy lungs were included in this prospective study (male:female, 48:27; age, 34±14 years; height, 172±7 cm; weight, 73±12 kg). The subjects were examined during spontaneous breathing in the supine position. EIT measurements were performed at the level of the 4th intercostal space. Commonly used EIT-based parameters, including the center of ventilation (CoV), dorsal and most dorsal fractions of ventilation distribution (TVD and TVROI4 respectively), global inhomogeneity (GI) index, and standard deviation of regional ventilation delay index (RVDSD) were calculated. Results Following outlier detection, EIT data from 71 subjects were finally evaluated. The values of the evaluated parameters were: CoV, 48.7%±1.7%; TVD, 48.1%±5.4%; TVROI4, 7.1%±1.8%; GI, 0.49±0.04; and RVDSD, 7.0±2.0. The coefficients of variation for CoV and GI were low (0.03 and 0.07, respectively), but those for TVROI4 and RVDSD were comparatively high (0.26 and 0.28, respectively). None of the evaluated parameters showed a significant correlation with age. The GI index showed a weak but significant correlation with body mass index (R=0.29, P=0.01). The RVDSD was slightly higher in males than in females. Conclusions Our study indicated that CoV and GI were stable parameters with small coefficients of variation in participants with healthy lungs. The creation of EIT parameter reference values for setting treatment targets may be feasible.
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Affiliation(s)
- Lin Yang
- Department of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Meng Dai
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Xinsheng Cao
- Department of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Knut Möller
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Mantas Dargvainis
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Tobias Becher
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Feng Fu
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.,Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
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Frerichs I, Vogt B, Wacker J, Paradiso R, Braun F, Rapin M, Caldani L, Chételat O, Weiler N. Multimodal remote chest monitoring system with wearable sensors: a validation study in healthy subjects. Physiol Meas 2020; 41:015006. [DOI: 10.1088/1361-6579/ab668f] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Gore A, Gauthier AG, Lin M, Patel V, Thomas DD, Ashby CR, Mantell LL. The nitric oxide donor, (Z)-1-[N-(2-aminoethyl)-N-(2-ammonioethyl)amino]diazen-1-ium-1,2-diolate (DETA-NONOate/D-NO), increases survival by attenuating hyperoxia-compromised innate immunity in bacterial clearance in a mouse model of ventilator-associated pneumonia. Biochem Pharmacol 2020; 176:113817. [PMID: 31972169 DOI: 10.1016/j.bcp.2020.113817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Abstract
Mechanical ventilation (MV) with supraphysiological levels of oxygen (hyperoxia) is a life-saving therapy for the management of patients with respiratory distress. However, a significant number of patients on MV develop ventilator-associated pneumonia (VAP). Previously, we have reported that prolonged exposure to hyperoxia impairs the capacity of macrophages to phagocytize Pseudomonas aeruginosa (PA), which can contribute to the compromised innate immunity in VAP. In this study, we show that the high mortality rate in mice subjected to hyperoxia and PA infection was accompanied by a significant decrease in the airway levels of nitric oxide (NO). Decreased NO levels were found to be, in part, due to a significant reduction in NO release by macrophages upon exposure to PA lipopolysaccharide (LPS). Based on these findings, we postulated that NO supplementation should restore hyperoxia-compromised innate immunity and decrease mortality by increasing the clearance of PA under hyperoxic conditions. To test this hypothesis, cultured macrophages were exposed to hyperoxia (95% O2) in the presence or absence of the NO donor, (Z)-1-[N-(2-aminoethyl)-N-(2-ammonioethyl)amino]diazen-1-ium-1,2-diolate (DETA-NONOate/D-NO). Interestingly, D-NO (up to 37.5 µM) significantly attenuated hyperoxia-compromised macrophage migratory, phagocytic, and bactericidal function. To determine whether the administration of exogenous NO enhances the host defense in bacteria clearance, C57BL/6 mice were exposed to hyperoxia (99% O2) and intranasally inoculated with PA in the presence or absence of D-NO. D-NO (300 µM-800 µM) significantly increased the survival of mice inoculated with PA under hyperoxic conditions, and significantly decreased bacterial loads in the lung and attenuated lung injury. These results suggest the NO donor, D-NO, can improve the clinical outcomes in VAP by augmenting the innate immunity in bacterial clearance. Thus, provided these results can be extrapolated to humans, NO supplementation may represent a potential therapeutic strategy for preventing and treating patients with VAP.
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Affiliation(s)
- Ashwini Gore
- Department of Pharmaceutical Sciences, St. John's University, College of Pharmacy and Health Sciences, Queens, NY 11439, USA
| | - Alex G Gauthier
- Department of Pharmaceutical Sciences, St. John's University, College of Pharmacy and Health Sciences, Queens, NY 11439, USA
| | - Mosi Lin
- Department of Pharmaceutical Sciences, St. John's University, College of Pharmacy and Health Sciences, Queens, NY 11439, USA
| | - Vivek Patel
- Department of Pharmaceutical Sciences, St. John's University, College of Pharmacy and Health Sciences, Queens, NY 11439, USA
| | - Douglas D Thomas
- Department of Medicinal Chemistry and Pharmacognosy, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Charles R Ashby
- Department of Pharmaceutical Sciences, St. John's University, College of Pharmacy and Health Sciences, Queens, NY 11439, USA
| | - Lin L Mantell
- Department of Pharmaceutical Sciences, St. John's University, College of Pharmacy and Health Sciences, Queens, NY 11439, USA; Cardiopulmonary Research, The Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY 11030, USA.
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Frerichs I, Zhao Z. Electrical impedance tomography for chest imaging in acute respiratory failure. Eur Respir J 2019; 54:54/4/1901497. [PMID: 31672905 DOI: 10.1183/13993003.01497-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 07/30/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Inéz Frerichs
- Dept of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Zhanqi Zhao
- Dept of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.,Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
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Integrated EIT system for functional lung ventilation imaging. Biomed Eng Online 2019; 18:83. [PMID: 31345220 PMCID: PMC6659234 DOI: 10.1186/s12938-019-0701-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023] Open
Abstract
Background Electrical impedance tomography (EIT) has been used for functional lung imaging of regional air distributions during mechanical ventilation in intensive care units (ICU). From numerous clinical and animal studies focusing on specific lung functions, a consensus about how to use the EIT technique has been formed lately. We present an integrated EIT system implementing the functions proposed in the consensus. The integrated EIT system could improve the usefulness when monitoring of mechanical ventilation for lung protection so that it could facilitate the clinical acceptance of this new technique. Methods Using a custom-designed 16-channel EIT system with 50 frames/s temporal resolution, the integrated EIT system software was developed to implement five functional images and six EIT measures that can be observed in real-time screen view and analysis screen view mode, respectively. We evaluated the performance of the integrated EIT system with ten mechanically ventilated porcine subjects in normal and disease models. Results Quantitative and simultaneous imaging of tidal volume (TV), end-expiratory lung volume change (\documentclass[12pt]{minimal}
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\begin{document}$$\triangle$$\end{document}▵EELV), compliance, ventilation delay, and overdistension/collapse images were performed. Clinically useful parameters were successfully extracted including anterior/posterior ventilation ratio (A/P ratio), center of ventilation (\documentclass[12pt]{minimal}
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\begin{document}$${\mathrm{CoV}}_{{x}}$$\end{document}CoVx, \documentclass[12pt]{minimal}
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\begin{document}$${\mathrm{CoV}}_{{y}}$$\end{document}CoVy), global inhomogeneity (GI), coefficient of variation (CV), ventilation delay and percentile of overdistension/collapse. The integrated EIT system was demonstrated to suggest an optimal positive end-expiratory pressure (PEEP) for lung protective ventilation in normal and in the disease model of an acute injury. Optimal PEEP for normal and disease model was 2.3 and \documentclass[12pt]{minimal}
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\begin{document}$$7.9 \, {\mathrm{cmH}}_{2}\mathrm{O}$$\end{document}7.9cmH2O, respectively. Conclusions The proposed integrated approach for functional lung ventilation imaging could facilitate clinical acceptance of the bedside EIT imaging method in ICU. Future clinical studies of applying the proposed methods to human subjects are needed to show the clinical significance of the method for lung protective mechanical ventilation and mechanical ventilator weaning in ICU.
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Aguiar Santos S, Czaplik M, Orschulik J, Hochhausen N, Leonhardt S. Lung pathologies analyzed with multi-frequency electrical impedance tomography: Pilot animal study. Respir Physiol Neurobiol 2018; 254:1-9. [DOI: 10.1016/j.resp.2018.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/13/2018] [Accepted: 03/30/2018] [Indexed: 11/26/2022]
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Mazzoni MB, Perri A, Plebani AM, Ferrari S, Amelio G, Rocchi A, Consonni D, Milani GP, Fossali EF. Electrical impedance tomography in children with community acquired pneumonia: preliminary data. Respir Med 2017; 130:9-12. [DOI: 10.1016/j.rmed.2017.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/23/2017] [Accepted: 07/03/2017] [Indexed: 11/30/2022]
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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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Gong B, Krueger-Ziolek S, Moeller K, Schullcke B, Zhao Z. Electrical impedance tomography: functional lung imaging on its way to clinical practice? Expert Rev Respir Med 2015; 9:721-37. [DOI: 10.1586/17476348.2015.1103650] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Journal of clinical monitoring and computing 2014 end of year summary: respiration. J Clin Monit Comput 2015; 29:209-15. [PMID: 25735264 DOI: 10.1007/s10877-015-9676-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
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