1
|
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.
Collapse
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
| |
Collapse
|
2
|
Roncon-Albuquerque R, Gaião S, Vasques-Nóvoa F, Basílio C, Ferreira AR, Touceda-Bravo A, Pimentel R, Vaz A, Silva S, Castro G, Veiga T, Martins H, Dias F, Pereira C, Marto G, Coimbra I, Chico-Carballas JI, Figueiredo P, Paiva JA. Standardized approach for extubation during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome: a prospective observational study. Ann Intensive Care 2023; 13:86. [PMID: 37723384 PMCID: PMC10506998 DOI: 10.1186/s13613-023-01185-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Extubation during extracorporeal oxygenation (ECMO) in severe acute respiratory distress syndrome (ARDS) has not been well studied. Despite the potential benefits of this strategy, weaning from ECMO before liberation from invasive mechanical ventilation remains the most frequent approach. Our aim was to evaluate the safety and feasibility of a standardized approach for extubation during ECMO in patients with severe ARDS. RESULTS We conducted a prospective observational study to assess the safety and feasibility of a standardized approach for extubation during ECMO in severe ARDS among 254 adult patients across 4 intensive care units (ICU) from 2 tertiary ECMO centers over 6 years. This consisted of a daily assessment of clinical and gas exchange criteria based on an Extracorporeal Life Support Organization guideline, with extubation during ECMO after validation by a dedicated intensive care medicine specialist. Fifty-four (21%) patients were extubated during ECMO, 167 (66%) did not reach the clinical criteria, and in 33 (13%) patients, gas exchange precluded extubation during ECMO. At ECMO initiation, there were fewer extrapulmonary organ dysfunctions (lower SOFA score [OR, 0.88; 95% CI, 0.79-0.98; P = .02] with similar PaO2/FiO2) when compared with patients not extubated during ECMO. Extubation during ECMO associated with shorter duration of invasive mechanical ventilation (7 (4-18) vs. 32 (18-54) days; P < .01) and of ECMO (12 (7-25) vs. 19 (10-41) days; P = .01). This was accompanied by a lower incidence of hemorrhagic shock (2 vs. 11%; P = .05), but more cannula-associated deep vein thrombosis (49 vs. 31%; P = .02) and failed extubation (20 vs. 6%; P < .01). There were no increased major adverse events. Extubation during ECMO is associated with a lower risk of all-cause death, independently of measured confounding (adjusted logistic regression OR 0.23; 95% confidence interval 0.08-0.69, P = .008). CONCLUSIONS A standardized approach was safe and feasible allowing extubation during ECMO in 21% of patients with severe ARDS, selecting patients who will have a shorter duration of invasive mechanical ventilation, ECMO course, and ICU stay, as well as fewer infectious complications, and high hospital survival.
Collapse
Affiliation(s)
- Roberto Roncon-Albuquerque
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Sérgio Gaião
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisco Vasques-Nóvoa
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Internal Medicine, São João University Hospital Centre, Porto, Portugal
| | - Carla Basílio
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Ana Rita Ferreira
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | | | - Rodrigo Pimentel
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Ana Vaz
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Sofia Silva
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Guiomar Castro
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Tiago Veiga
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Hélio Martins
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Francisco Dias
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Catarina Pereira
- Department of Internal Medicine, São João University Hospital Centre, Porto, Portugal
| | - Gonçalo Marto
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Isabel Coimbra
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | | | - Paulo Figueiredo
- Department of Infectious Diseases, São João University Hospital Centre, Porto, Portugal
| | - José Artur Paiva
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
3
|
Pan Q, Pan J, Zhang Z, Fang L, Ge H. Assessment of respiratory system compliance under pressure control ventilation without an inspiratory pause maneuver. Physiol Meas 2021; 42. [PMID: 34384069 DOI: 10.1088/1361-6579/ac1d3b] [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: 03/17/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023]
Abstract
Objective. The measurement of the static compliance of the respiratory system (Cstat) during mechanical ventilation requires zero end-inspiratory flow. An inspiratory pause maneuver is needed if the zero end-inspiratory flow condition cannot be satisfied under normal ventilation.Approach. We propose a method to measure the quasi-static respiratory compliance (Cqstat) under pressure control ventilation mode without the inspiratory pause maneuver. First, a screening strategy was applied to filter out breaths affected strongly by spontaneous breathing efforts or artifacts. Then, we performed a virtual extrapolation of the flow-time waveform when the end-inspiratory flow was not zero, to allow for the calculation ofCqstatfor each kept cycle. Finally, the outputCqstatwas obtained as the average of the smallest 40Cqstatmeasurements. The proposed method was validated against the gold standardCstatmeasured from real clinical settings and compared with two reported algorithms. The gold standardCstatwas obtained by applying an end-inspiratory pause maneuver in the volume-control ventilation mode.Main results. Sixty-nine measurements from 36 patients were analyzed. The Bland-Altman analysis showed that the bias of agreement forCqstatversus the gold standard measurement was -0.267 ml/cmH2O (95% limits of agreement was -4.279 to 4.844 ml/cmH2O). The linear regression analysis indicated a strong correlation (R2 = 0.90) between theCqstatand gold standard.Significance. The results showed that theCqstatcan be accurately estimated from continuous ventilator waveforms, including spontaneous breathing without an inspiratory pause maneuver. This method promises to provide continuous measurements compliant with mechanical ventilation.
Collapse
Affiliation(s)
- Qing Pan
- College of Information Engineering, Zhejiang University of Technology, Liuhe Rd. 288, Hangzhou 310023, People's Republic of China
| | - Jie Pan
- College of Information Engineering, Zhejiang University of Technology, Liuhe Rd. 288, Hangzhou 310023, People's Republic of China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Qingchun East Rd. 3, Hangzhou 310016, People's Republic of China
- Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University, Haikou 571199, People's Republic of China
| | - Luping Fang
- College of Information Engineering, Zhejiang University of Technology, Liuhe Rd. 288, Hangzhou 310023, People's Republic of China
| | - Huiqing Ge
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Qingchun East Rd. 3, Hangzhou 310016, People's Republic of China
| |
Collapse
|
4
|
Chen WY, Lin CH, Lee YS, Tsao PC, Jeng MJ. Pathophysiological effects of intravenous phosphodiesterase type 4 inhibitor in addition to surfactant lavage in meconium-injured newborn piglet lungs. Pediatr Pulmonol 2020; 55:2272-2282. [PMID: 32478966 DOI: 10.1002/ppul.24880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs, such as selective phosphodiesterase type 4 (PDE4) inhibitors have potential anti-inflammatory and respiratory smooth muscle relaxation effects. This study aimed to investigate the pathophysiological effects of an intravenous PDE4 inhibitor (rolipram) and surfactant lavage (SL) in a newborn piglet model of meconium aspiration syndrome (MAS). METHODS MAS was induced in 25 newborn piglets, which were randomly divided into control and four SL treatment groups administered with different doses of intravenous rolipram (0, 0.1, 0.5, and 1 mg/kg). Cardiopulmonary variables were monitored and recorded. The experimental time was 4 hours. Serial blood was drawn for blood gas and biomarker analyses. Lung tissue was examined for histological analysis. RESULTS All SL-treated groups revealed improved oxygenation during the 4-hour experiments and had significantly lower peak inspiratory pressure levels than the control group at the end of experiments. All SL plus rolipram-treated groups exhibited significantly higher lung compliance than the control group. However, the animals receiving high-dose (0.5 and 1.0 mg/kg) rolipram demonstrated significantly elevated heart rates. Lung histology of the nondependent sites revealed significantly lower lung injury scores in all SL-treated groups compared with that in the control group, but there were no differences among the rolipram-treated groups. CONCLUSIONS In addition to SL, intravenous PDE4 inhibitors may further improve lung compliance in treating MAS; however, it is necessary to consider cardiovascular adverse effects, primarily tachycardia. Further investigations are required before the clinical application of intravenous PDE4 inhibitor as an anti-inflammatory agent to treat severe MAS.
Collapse
Affiliation(s)
- Wei-Yu Chen
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Hsueh Lin
- Department of Nutrition, Master Program of BioMedical Nutrition, HungKuang University, Taichung, Taiwan
| | - Yu-Sheng Lee
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Chen Tsao
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Jy Jeng
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
5
|
Karbing DS, Perchiazzi G, Rees SE, Jaffe MB. Journal of Clinical Monitoring and Computing 2018-2019 end of year summary: respiration. J Clin Monit Comput 2020; 34:197-205. [PMID: 31981067 PMCID: PMC7223067 DOI: 10.1007/s10877-020-00468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 11/25/2022]
Abstract
This paper reviews 28 papers or commentaries published in Journal of Clinical Monitoring and Computing in 2018 and 2019, within the field of respiration. Papers were published covering endotracheal tube cuff pressure monitoring, ventilation and respiratory rate monitoring, lung mechanics monitoring, gas exchange monitoring, CO2 monitoring, lung imaging, and technologies and strategies for ventilation management.
Collapse
Affiliation(s)
- D S Karbing
- Respiratory and Critical Care Group (Rcare), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - G Perchiazzi
- Department of Surgical Sciences, The Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
| | - S E Rees
- Respiratory and Critical Care Group (Rcare), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - M B Jaffe
- Cardiorespiratory Consulting, LLC, Cheshire, CT, USA
| |
Collapse
|