1
|
Xiao L, Yu K, Yang JJ, Liu WT, Liu L, Miao HH, Li TZ. Effect of individualized positive end-expiratory pressure based on electrical impedance tomography guidance on pulmonary ventilation distribution in patients who receive abdominal thermal perfusion chemotherapy. Front Med (Lausanne) 2023; 10:1198720. [PMID: 37731718 PMCID: PMC10507689 DOI: 10.3389/fmed.2023.1198720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Abstract
Background Electrical impedance tomography (EIT) has been shown to be useful in guiding individual positive end-expiratory pressure titration for patients with mechanical ventilation. However, the appropriate positive end-expiratory pressure (PEEP) level and whether the individualized PEEP needs to be adjusted during long-term surgery (>6 h) were unknown. Meanwhile, the effect of individualized PEEP on the distribution of pulmonary ventilation in patients who receive abdominal thermoperfusion chemotherapy is unknown. The primary aim of this study was to observe the effect of EIT-guided PEEP on the distribution of pulmonary ventilation in patients undergoing cytoreductive surgery (CRS) combined with hot intraperitoneal chemotherapy (HIPEC). The secondary aim was to analyze their effect on postoperative pulmonary complications. Methods A total of 48 patients were recruited and randomly divided into two groups, with 24 patients in each group. For the control group (group A), PEEP was set at 5 cm H2O, while in the EIT group (group B), individual PEEP was titrated and adjusted every 2 h with EIT guidance. Ventilation distribution, respiratory/circulation parameters, and PPC incidence were compared between the two groups. Results The average individualized PEEP was 10.3 ± 1.5 cm H2O, 10.2 ± 1.6 cm H2O, 10.1 ± 1.8 cm H2O, and 9.7 ± 2.1 cm H2O at 5 min, 2 h, 4 h, and 6 h after tracheal intubation during CRS + HIPEC. Individualized PEEP was correlated with ventilation distribution in the regions of interest (ROI) 1 and ROI 3 at 4 h mechanical ventilation and ROI 1 at 6 h mechanical ventilation. The ventilation distribution under individualized PEEP was back-shifted for 6 h but moved to the control group's ventral side under PEEP 5 cm H2O. The respiratory and circulatory function indicators were both acceptable either under individualized PEEP or PEEP 5 cm H2O. The incidence of total PPCs was significantly lower under individualized PEEP (66.7%) than PEEP 5 cm H2O (37.5%) for patients with CRS + HIPEC. Conclusion The appropriate individualized PEEP was stable at approximately 10 cm H2O during 6 h for patients with CRS + HIPEC, along with better ventilation distribution and a lower total PPC incidence than the fixed PEEP of 5 cm H2O.Clinical trial registration: identifier ChiCTR1900023897.
Collapse
Affiliation(s)
- Li Xiao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Kang Yu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jiao-Jiao Yang
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wen-Tao Liu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Lei Liu
- Department of Science and Technology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hui-Hui Miao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Tian-Zuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
2
|
Pennati F, Angelucci A, Morelli L, Bardini S, Barzanti E, Cavallini F, Conelli A, Di Federico G, Paganelli C, Aliverti A. Electrical Impedance Tomography: From the Traditional Design to the Novel Frontier of Wearables. SENSORS (BASEL, SWITZERLAND) 2023; 23:1182. [PMID: 36772222 PMCID: PMC9921522 DOI: 10.3390/s23031182] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Electrical impedance tomography (EIT) is a medical imaging technique based on the injection of a current or voltage pattern through electrodes on the skin of the patient, and on the reconstruction of the internal conductivity distribution from the voltages collected by the electrodes. Compared to other imaging techniques, EIT shows significant advantages: it does not use ionizing radiation, is non-invasive and is characterized by high temporal resolution. Moreover, its low cost and high portability make it suitable for real-time, bedside monitoring. However, EIT is also characterized by some technical limitations that cause poor spatial resolution. The possibility to design wearable devices based on EIT has recently given a boost to this technology. In this paper we reviewed EIT physical principles, hardware design and major clinical applications, from the classical to a wearable setup. A wireless and wearable EIT system seems a promising frontier of this technology, as it can both facilitate making clinical measurements and open novel scenarios to EIT systems, such as home monitoring.
Collapse
Affiliation(s)
| | - Alessandra Angelucci
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Artaud-Macari E, Bubenheim M, Le Bouar G, Carpentier D, Grangé S, Boyer D, Béduneau G, Misset B, Cuvelier A, Tamion F, Girault C. High-flow oxygen therapy versus noninvasive ventilation: a randomised physiological crossover study of alveolar recruitment in acute respiratory failure. ERJ Open Res 2021; 7:00373-2021. [PMID: 34912882 PMCID: PMC8666576 DOI: 10.1183/23120541.00373-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/10/2021] [Indexed: 11/05/2022] Open
Abstract
High-flow nasal cannula (HFNC) oxygen therapy has recently shown clinical benefits in hypoxaemic acute respiratory failure (ARF) patients, while the value of noninvasive ventilation (NIV) remains debated. The primary end-point was to compare alveolar recruitment using global end-expiratory electrical lung impedance (EELI) between HFNC and NIV. Secondary end-points compared regional EELI, lung volumes (global and regional tidal volume variation (VT)), respiratory parameters, haemodynamic tolerance, dyspnoea and patient comfort between HFNC and NIV, relative to face mask (FM). A prospective randomised crossover physiological study was conducted in patients with hypoxaemic ARF due to pneumonia. They received alternately HFNC, NIV and FM. 16 patients were included. Global EELI was 4083 with NIV and 2921 with HFNC (p=0.4). Compared to FM, NIV and HFNC significantly increased global EELI by 1810.5 (95% CI 857–2646) and 826 (95% CI 399.5–2361), respectively. Global and regional VT increased significantly with NIV compared to HFNC or FM, but not between HFNC and FM. NIV yielded a significantly higher pulse oxygen saturation/inspired oxygen fraction ratio compared to HFNC (p=0.03). No significant difference was observed between HFNC, NIV and FM for dyspnoea. Patient comfort score with FM was not significantly different than with HFNC (p=0.1), but was lower with NIV (p=0.001). This study suggests a potential benefit of HFNC and NIV on alveolar recruitment in patients with hypoxaemic ARF. In contrast with HFNC, NIV increased lung volumes, which may contribute to overdistension and its potentially deleterious effect in these patients. This study found a potential benefit of HFNC and NIV on alveolar recruitment in patients with hypoxaemic ARF, but NIV also increases lung volumes, which may give rise to overdistension, reinforcing the concept of patient self-inflicted lung injuryhttps://bit.ly/3iRcZDJ
Collapse
Affiliation(s)
- Elise Artaud-Macari
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France.,Rouen University Hospital, Pulmonary, Thoracic Oncology and Respiratory Intensive Care Unit, F-76000, Rouen, France.,Normandie Université, UNIROUEN, EA3830, Rouen University Hospital, F-76000, Rouen, France
| | - Michael Bubenheim
- Rouen University Hospital, Dept of Clinical Research and Innovation, F-76000, Rouen, France
| | - Gurvan Le Bouar
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France.,Rouen University Hospital, Pulmonary, Thoracic Oncology and Respiratory Intensive Care Unit, F-76000, Rouen, France
| | - Dorothée Carpentier
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France
| | - Steven Grangé
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France
| | - Déborah Boyer
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France
| | - Gaëtan Béduneau
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France.,Normandie Université, UNIROUEN, EA3830, Rouen University Hospital, F-76000, Rouen, France
| | - Benoit Misset
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France.,Dept of Intensive Care, Liège University Hospital, Liège, Belgium
| | - Antoine Cuvelier
- Rouen University Hospital, Pulmonary, Thoracic Oncology and Respiratory Intensive Care Unit, F-76000, Rouen, France.,Normandie Université, UNIROUEN, EA3830, Rouen University Hospital, F-76000, Rouen, France
| | - Fabienne Tamion
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France.,Normandie Université, UNIROUEN, IRIB, Inserm U 1096, Rouen University Hospital, F-76000, Rouen, France
| | - Christophe Girault
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France.,Normandie Université, UNIROUEN, EA3830, Rouen University Hospital, F-76000, Rouen, France
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Vasques F, Sanderson B, Barrett NA, Camporota L. Monitoring of regional lung ventilation using electrical impedance tomography. Minerva Anestesiol 2019; 85:1231-1241. [PMID: 30945516 DOI: 10.23736/s0375-9393.19.13477-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Among recent lung imaging techniques and devices, electrical impedance tomography (EIT) can provide dynamic information on the distribution regional lung ventilation. EIT images possess a high temporal and functional resolution allowing the visualization of dynamic physiological and pathological changes on a breath-by-breath basis. EIT detects changes in electric impedance (i.e., changes in gas/fluid ratio) and describes them in real time, both visually through images and waveforms, and numerically, allowing the clinician to monitor disease evolution and response to treatment. The use of EIT in clinical practice is supported by several studies demonstrating a good correlation between impedance tomography data and other validated methods of measuring lung volume. In this review, we will provide an overview on the rationale, basic functioning and most common applications of EIT in the management of mechanically ventilated patients.
Collapse
Affiliation(s)
- Francesco Vasques
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK.,Division of Centre of Human Applied Physiological Sciences, King's College London, London, UK
| | - Barnaby Sanderson
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK.,Division of Centre of Human Applied Physiological Sciences, King's College London, London, UK
| | - Nicholas A Barrett
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK.,Division of Centre of Human Applied Physiological Sciences, King's College London, London, UK
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK - .,Division of Centre of Human Applied Physiological Sciences, King's College London, London, UK
| |
Collapse
|
6
|
The role of electrical impedance tomography for monitoring during bronchoscopy: A case report. J Crit Care 2018; 48:311-313. [DOI: 10.1016/j.jcrc.2018.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/24/2018] [Accepted: 09/22/2018] [Indexed: 11/21/2022]
|
7
|
Bialka S, Copik M, Rybczyk K, Owczarek A, Jedrusik E, Czyzewski D, Filipowski M, Rivas E, Ruetzler K, Szarpak L, Misiolek H. Assessment of changes of regional ventilation distribution in the lung tissue depending on the driving pressure applied during high frequency jet ventilation. BMC Anesthesiol 2018; 18:101. [PMID: 30064377 PMCID: PMC6069840 DOI: 10.1186/s12871-018-0552-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/27/2018] [Indexed: 12/26/2022] Open
Abstract
Background Electrical impedance tomography (EIT) is a tool to monitor regional ventilation distribution in patient’s lungs under general anesthesia. The objective of this study was to assess the regional ventilation distribution using different driving pressures (DP) during high frequency jet ventilation (HFJV). Methods Prospective, observational, cross-over study. Patients undergoing rigid bronchoscopy were ventilated HFJV with DP 1.5 and 2.5 atm. Hemodynamic and ventilation parameters, as well as ventilation in different regions of the lungs in percentage of total ventilation, assessed by EIT, were recorded. Results Thirty-six patients scheduled for elective rigid bronchoscopy. The final analysis included thirty patients. There was no significant difference in systolic, diastolic and mean arterial blood pressure, heart rate, and peripheral saturation between the two groups. Peak inspiratory pressure, mean inspiratory pressure, tidal volume, and minute volume significantly increased in the second, compared to the first intervention group. Furthermore, there were no statistically significant differences between each time profiles in all ROI regions in EIT. Conclusions In our study intraoperative EIT was an effective method of functional monitoring of the lungs during HFJV for rigid bronchoscopy procedure. Lower driving pressure was as effective in providing sufficient ventilation distribution through the lungs as the higher driving pressure but characterized by lower airway pressure. Trial registration The study was registered on ClinicalTrials.gov under no. NCT02997072.
Collapse
Affiliation(s)
- Szymon Bialka
- Chair and Department of Anesthesiology, Intensive Therapy and Emergency Medicine, Medical University of Silesia, Katowice, Poland
| | - Maja Copik
- Chair and Department of Anesthesiology, Intensive Therapy and Emergency Medicine, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Rybczyk
- Chair and Department of Anesthesiology, Intensive Therapy and Emergency Medicine, Medical University of Silesia, Katowice, Poland
| | - Aleksander Owczarek
- Department of Statistics, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Ewa Jedrusik
- Department of Statistics, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Damian Czyzewski
- Chair and Department of Chest Surgery, Medical University of Silesia, Katowice, Poland
| | - Marek Filipowski
- Chair and Department of Chest Surgery, Medical University of Silesia, Katowice, Poland
| | - Eva Rivas
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.,Hospital Clinic of Barcelona, IDIBPAS, University of Barcelona, Barcelona, Spain
| | - Kurt Ruetzler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Lukasz Szarpak
- Lazarski University, 43 Swieradowska Str, 02-662, Warsaw, Poland.
| | - Hanna Misiolek
- Chair and Department of Anesthesiology, Intensive Therapy and Emergency Medicine, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Bickenbach J, Czaplik M, Polier M, Marx G, Marx N, Dreher M. Electrical impedance tomography for predicting failure of spontaneous breathing trials in patients with prolonged weaning. Crit Care 2017; 21:177. [PMID: 28697778 PMCID: PMC5506613 DOI: 10.1186/s13054-017-1758-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 06/19/2017] [Indexed: 11/23/2022] Open
Abstract
Background Spontaneous breathing trials (SBTs) on a T-piece can be difficult in patients with prolonged weaning because of remaining de-recruitment phenomena and/or insufficient ventilation. There is no clinically established method existent other than experience for estimating whether an SBT is most probably beneficial. Electrical impedance tomography (EIT) is a clinical useful online monitoring technique during mechanical ventilation, particularly because it enables analysis of effects of regional ventilation distribution. The aim of our observational study was to examine if EIT can predict whether patients with prolonged weaning will benefit from a planned SBT. Methods Thirty-one patients were examined. Blood gas analysis, vital parameter measurements, and EIT recordings were performed at three time points: (1) baseline with pressure support ventilation (PSV) (t0), (2) during a T-piece trial (t1), and (3) after resumption of PSV (t2). Calculation of EIT parameters was performed, including the impedance ratio (IR), the tidal variation of impedance (TIV), the changes in end-expiratory lung impedance (ΔEELI), the global inhomogeneity index (GI), and the regional ventilation delay (RVD) index with use of different thresholds of the percentage inspiration time (RVD40, RVD60, RVD80). The predictive power of the baseline GI with regard to clinical impairment of an SBT was analyzed by means of ROC curves. Clinical deterioration was assumed when tidal volume was decreased by at least 20 ml after the T-piece trial, measured at t2. Results Partial pressure of arterial oxygen significantly decreased at t1 (71 ± 15 mmHg) compared with t0 (85 ± 17 mmHg, p < 0.05) and t2 (82 ± 18 mmHg, p < 0.05). The IR trended toward higher values during t1. At t1, TIV and ΔEELI significantly decreased. The GI was significantly increased at t1 (t0 59.3 ± 46.1 vs t1 81.5 ± 62.5, p = 0.001), as were all RVD indexes. Assuming a GI cutoff value of >40, sensitivity of 85% and specificity of 50% were reached for predicting an increased future tidal volume. Conclusions EIT enables monitoring of regional ventilation distribution during SBTs and is suitable to estimate whether an SBT probably will be beneficial for an individual patient. Therefore, the application of EIT can support clinical decisions regarding patients in the phase of prolonged weaning.
Collapse
Affiliation(s)
- Johannes Bickenbach
- Department of Intensive Care Medicine, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Michael Czaplik
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Mareike Polier
- Department of Intensive Care Medicine, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Dreher
- Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| |
Collapse
|
10
|
Frerichs I, Amato MBP, van Kaam AH, Tingay DG, Zhao Z, Grychtol B, Bodenstein M, Gagnon H, Böhm SH, Teschner E, Stenqvist O, Mauri T, Torsani V, Camporota L, Schibler A, Wolf GK, Gommers D, Leonhardt S, Adler A. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax 2016; 72:83-93. [PMID: 27596161 PMCID: PMC5329047 DOI: 10.1136/thoraxjnl-2016-208357] [Citation(s) in RCA: 490] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/12/2016] [Accepted: 07/16/2016] [Indexed: 11/04/2022]
Abstract
Electrical impedance tomography (EIT) has undergone 30 years of development. Functional chest examinations with this technology are considered clinically relevant, especially for monitoring regional lung ventilation in mechanically ventilated patients and for regional pulmonary function testing in patients with chronic lung diseases. As EIT becomes an established medical technology, it requires consensus examination, nomenclature, data analysis and interpretation schemes. Such consensus is needed to compare, understand and reproduce study findings from and among different research groups, to enable large clinical trials and, ultimately, routine clinical use. Recommendations of how EIT findings can be applied to generate diagnoses and impact clinical decision-making and therapy planning are required. This consensus paper was prepared by an international working group, collaborating on the clinical promotion of EIT called TRanslational EIT developmeNt stuDy group. It addresses the stated needs by providing (1) a new classification of core processes involved in chest EIT examinations and data analysis, (2) focus on clinical applications with structured reviews and outlooks (separately for adult and neonatal/paediatric patients), (3) a structured framework to categorise and understand the relationships among analysis approaches and their clinical roles, (4) consensus, unified terminology with clinical user-friendly definitions and explanations, (5) a review of all major work in thoracic EIT and (6) recommendations for future development (193 pages of online supplements systematically linked with the chief sections of the main document). We expect this information to be useful for clinicians and researchers working with EIT, as well as for industry producers of this technology.
Collapse
Affiliation(s)
- Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Marcelo B P Amato
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - David G Tingay
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Zhanqi Zhao
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Bartłomiej Grychtol
- Fraunhofer Project Group for Automation in Medicine and Biotechnology PAMB, Mannheim, Germany
| | - Marc Bodenstein
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Hervé Gagnon
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | | | | | - Ola Stenqvist
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vinicius Torsani
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Mater Research University of Queensland, South Brisbane, Australia
| | - Gerhard K Wolf
- Children's Hospital Traunstein, Ludwig Maximilian's University, Munich, Germany
| | - Diederik Gommers
- Department of Adult Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | - Steffen Leonhardt
- Philips Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Andy Adler
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | | |
Collapse
|
11
|
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.
Collapse
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.
| |
Collapse
|
12
|
Romero A, Alonso B, Latorre I, García J. Respiratory monitoring with electrical impedance tomography for lung protective ventilation and alveolar recruitment maneuver in a patient with a single lung transplant and early graft dysfunction. ACTA ACUST UNITED AC 2015; 63:347-52. [PMID: 26633603 DOI: 10.1016/j.redar.2015.09.003] [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: 06/03/2015] [Revised: 08/26/2015] [Accepted: 09/02/2015] [Indexed: 12/16/2022]
Abstract
A case is presented on a patient who underwent left single lung transplantation for emphysema type COPD. There was early graft dysfunction gradeiii during the immediate postoperative period, which required the implantation of an extracorporeal membrane oxygenator (ECMO). Respirator ventilatory parameters were adjusted to avoid lung distension, low tidal volume (Vc) (280ml), high respiratory rates (20rpm), and a positive pressure at end expiration (PEEP) level of 8cmH2O. On monitoring the pulmonary tidal volume distribution by bedside electrical impedance tomography (EIT), it was noted that most of the tidal volume was distributed in the native lung emphysema. An alveolar recruitment manoeuvre was performed, under control of the EIT, that enabled the current volume and distribution and the pressures required to ventilate the transplanted lung to be observed.
Collapse
Affiliation(s)
- A Romero
- Departamento de Anestesiología, Reanimación y Cuidados Críticos, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España.
| | - B Alonso
- Departamento de Anestesiología, Reanimación y Cuidados Críticos, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - I Latorre
- Departamento de Anestesiología, Reanimación y Cuidados Críticos, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - J García
- Departamento de Anestesiología, Reanimación y Cuidados Críticos, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| |
Collapse
|
13
|
Suzuki S, Eastwood GM, Goodwin MD, Noë GD, Smith PE, Glassford N, Schneider AG, Bellomo R. Atelectasis and mechanical ventilation mode during conservative oxygen therapy: A before-and-after study. J Crit Care 2015; 30:1232-7. [PMID: 26346814 DOI: 10.1016/j.jcrc.2015.07.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of the study is to assess the effect of a conservative oxygen therapy (COT) (target SpO2 of 90%-92%) on radiological atelectasis and mechanical ventilation modes. MATERIALS AND METHODS We conducted a secondary analysis of 105 intensive care unit patients from a pilot before-and-after study. The primary outcomes of this study were changes in atelectasis score (AS) of 555 chest radiographs assessed by radiologists blinded to treatment allocation and time to weaning from mandatory ventilation and first spontaneous ventilation trial (SVT). RESULTS There was a significant difference in overall AS between groups, and COT was associated with lower time-weighted average AS. In addition, in COT patients, change from mandatory to spontaneous ventilation or time to first SVT was shortened. After adjustment for baseline characteristics and interactions between oxygen therapy, radiological atelectasis, and mechanical ventilation management, patients in the COT group had significantly lower "best" AS (adjusted odds ratio, 0.28 [95% confidence interval {CI}, 0.12-0.66]; P=.003) and greater improvement in AS in the first 7 days (adjusted odds ratio, 0.42 [95% CI, 0.17-0.99]; P=.049). Moreover, COT was associated with significantly earlier successful weaning from a mandatory ventilation mode (adjusted hazard ratio, 2.96 [95% CI, 1.73-5.04]; P<.001) and with shorter time to first SVT (adjusted hazard ratio, 1.77 [95% CI, 1.13-2.78]; P=.013). CONCLUSIONS In mechanically ventilated intensive care unit patients, COT might be associated with decreased radiological evidence of atelectasis, earlier weaning from mandatory ventilation modes, and earlier first trial of spontaneous ventilation.
Collapse
Affiliation(s)
- Satoshi Suzuki
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia
| | - Glenn M Eastwood
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia
| | - Mark D Goodwin
- Department of Radiology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Geertje D Noë
- Department of Radiology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Paul E Smith
- Department of Radiology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Neil Glassford
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia
| | - Antoine G Schneider
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Melbourne, VIC, Australia.
| |
Collapse
|
14
|
Electrical impedance tomography: the holy grail of ventilation and perfusion monitoring? Intensive Care Med 2012; 38:1917-29. [DOI: 10.1007/s00134-012-2684-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 08/08/2012] [Indexed: 01/08/2023]
|
15
|
Vogt B, Pulletz S, Elke G, Zhao Z, Zabel P, Weiler N, Frerichs I. Spatial and temporal heterogeneity of regional lung ventilation determined by electrical impedance tomography during pulmonary function testing. J Appl Physiol (1985) 2012; 113:1154-61. [PMID: 22898553 DOI: 10.1152/japplphysiol.01630.2011] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Electrical impedance tomography (EIT) is a functional imaging modality capable of tracing continuously regional pulmonary gas volume changes. The aim of our study was to determine if EIT was able to assess spatial and temporal heterogeneity of ventilation during pulmonary function testing in 14 young (37 ± 10 yr, mean age ± SD) and 12 elderly (71 ± 9 yr) subjects without lung disease and in 33 patients with chronic obstructive pulmonary disease (71 ± 9 yr). EIT and spirometry examinations were performed during tidal breathing and a forced vital capacity (FVC) maneuver preceded by full inspiration to total lung capacity. Regional inspiratory vital capacity (IVC); FVC; forced expiratory volume in 1 s (FEV(1)); FEV(1)/FVC; times required to expire 25%, 50%, 75%, and 90% of FVC (t(25), t(50), t(75), t(90)); and tidal volume (V(T)) were determined in 912 EIT image pixels in the chest cross section. Coefficients of variation (CV) were calculated from all pixel values of IVC, FVC, FEV(1), and V(T) to characterize the ventilation heterogeneity. The highest values were found in patients, and no differences existed between the healthy young and elderly subjects. Receiver-operating characteristics curves showed that CV of regional IVC, FVC, FEV(1), and V(T) discriminated the young and elderly subjects from the patients. Frequency distributions of pixel FEV(1)/FVC, t(25), t(50), t(75), and t(90) identified the highest ventilation heterogeneity in patients but distinguished also the healthy young from the elderly subjects. These results indicate that EIT may provide additional information during pulmonary function testing and identify pathologic and age-related spatial and temporal heterogeneity of regional lung function.
Collapse
Affiliation(s)
- Barbara Vogt
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, Kiel, Germany
| | | | | | | | | | | | | |
Collapse
|
16
|
Riera J, Riu PJ, Casan P, Masclans JR. [Electrical impedance tomography in acute lung injury]. Med Intensiva 2011; 35:509-17. [PMID: 21680060 DOI: 10.1016/j.medin.2011.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 05/01/2011] [Accepted: 05/03/2011] [Indexed: 01/18/2023]
Abstract
Electrical impedance tomography has been described as a new method of monitoring critically ill patients on mechanical ventilation. It has recently gained special interest because of its applicability for monitoring ventilation and pulmonary perfusion. Its bedside and continuous implementation, and the fact that it is a non-ionizing and non-invasive technique, makes it an extremely attractive measurement tool. Likewise, given its ability to assess the regional characteristics of lung structure, it could be considered an ideal monitoring tool in the heterogeneous lung with acute lung injury. This review explains the physical concept of bioimpedance and its clinical application, and summarizes the scientific evidence published to date with regard to the implementation of electrical impedance tomography as a method for monitoring ventilation and perfusion, mainly in the patient with acute lung injury, and other possible applications of the technique in the critically ill patient. The review also summarizes the limitations of the technique and its potential areas of future development.
Collapse
Affiliation(s)
- J Riera
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, España.
| | | | | | | |
Collapse
|
17
|
Elke G, Pulletz S, Schädler D, Zick G, Gawelczyk B, Frerichs I, Weiler N. Measurement of regional pulmonary oxygen uptake—a novel approach using electrical impedance tomography. Physiol Meas 2011; 32:877-86. [DOI: 10.1088/0967-3334/32/7/s11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
18
|
Denaï MA, Mahfouf M, Mohamad-Samuri S, Panoutsos G, Brown BH, Mills GH. Absolute electrical impedance tomography (aEIT) guided ventilation therapy in critical care patients: simulations and future trends. IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE : A PUBLICATION OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY 2010; 14:641-9. [PMID: 19906599 PMCID: PMC7176469 DOI: 10.1109/titb.2009.2036010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 09/11/2009] [Indexed: 11/19/2022]
Abstract
Thoracic electrical impedance tomography (EIT) is a noninvasive, radiation-free monitoring technique whose aim is to reconstruct a cross-sectional image of the internal spatial distribution of conductivity from electrical measurements made by injecting small alternating currents via an electrode array placed on the surface of the thorax. The purpose of this paper is to discuss the fundamentals of EIT and demonstrate the principles of mechanical ventilation, lung recruitment, and EIT imaging on a comprehensive physiological model, which combines a model of respiratory mechanics, a model of the human lung absolute resistivity as a function of air content, and a 2-D finite-element mesh of the thorax to simulate EIT image reconstruction during mechanical ventilation. The overall model gives a good understanding of respiratory physiology and EIT monitoring techniques in mechanically ventilated patients. The model proposed here was able to reproduce consistent images of ventilation distribution in simulated acutely injured and collapsed lung conditions. A new advisory system architecture integrating a previously developed data-driven physiological model for continuous and noninvasive predictions of blood gas parameters with the regional lung function data/information generated from absolute EIT (aEIT) is proposed for monitoring and ventilator therapy management of critical care patients.
Collapse
Affiliation(s)
- Mouloud A. Denaï
- Department of Automatic Control and Systems EngineeringUniversity of SheffieldSheffieldS3 7GGU.K.
| | - Mahdi Mahfouf
- Department of Automatic Control and Systems EngineeringUniversity of SheffieldSheffieldS3 7GGU.K.
| | - Suzani Mohamad-Samuri
- Department of Automatic Control and Systems EngineeringUniversity of SheffieldSheffieldS3 7GGU.K.
| | - George Panoutsos
- Department of Automatic Control and Systems EngineeringUniversity of SheffieldSheffieldS3 7GGU.K.
| | - Brian H. Brown
- Department of Medical PhysicsUniversity of SheffieldSheffieldS10 2JFU.K.
| | - Gary H. Mills
- Department of Critical Care and AnaesthesiaNorthern General HospitalSheffieldS5 7AUU.K.
- University of SheffieldSheffieldS3 7GGU.K.
| |
Collapse
|
19
|
Ventilatory support for acute respiratory failure: new and ongoing pathophysiological, diagnostic and therapeutic developments. Curr Opin Crit Care 2010; 16:1-7. [PMID: 19952735 DOI: 10.1097/mcc.0b013e32833500bc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Acute respiratory failure and its most severe form, the acute respiratory distress syndrome, are relatively common in the ICU setting and have a high morbidity and mortality. This article will discuss ongoing research in this area, with a focus on relatively novel approaches in terms of pathophysiology, diagnosis and therapeutic advancements. RECENT FINDINGS Several novel diagnostic and therapeutic tools, such as electrical impedance tomography, high frequency oscillatory ventilation, minimally invasive extracorporeal CO2 removal devices and neurally adjusted ventilatory assist, have recently been studied to minimize ventilator-induced lung injury. A brief review of these studies is presented in this article. SUMMARY It is increasingly evident that only integration of physiological, clinical and technological approaches will lead to improvement in the outcome of patients with acute respiratory failure.
Collapse
|
20
|
|
21
|
Adam JF, Bayat S, Porra L, Elleaume H, Estève F, Suortti P. QUANTITATIVE FUNCTIONAL IMAGING AND KINETIC STUDIES WITH HIGH-Z CONTRAST AGENTS USING SYNCHROTRON RADIATION COMPUTED TOMOGRAPHY. Clin Exp Pharmacol Physiol 2009; 36:95-106. [DOI: 10.1111/j.1440-1681.2008.05043.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Soni N, Williams P. Positive pressure ventilation: what is the real cost? Br J Anaesth 2008; 101:446-57. [PMID: 18782885 DOI: 10.1093/bja/aen240] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Positive pressure ventilation is a radical departure from the physiology of breathing spontaneously. The immediate physiological consequences of positive pressure ventilation such as haemodynamic changes are recognized, studied, and understood. There are other significant physiological interactions which are less obvious, more insidious, and may only produce complications if ventilation is prolonged. The interaction of positive pressure with airway resistance and alveolar compliance affects distribution of gas flow within the lung. The result is a wide range of ventilation efficacy throughout different areas of the lung, but the pressure differentials between alveolus and interstitium also influence capillary perfusion. The hydrostatic forces across the capillaries associated with the effects of raised venous pressures compound these changes resulting in interstitial fluid sequestration. This is increased by impaired lymphatic drainage which is secondary to raised intrathoracic pressure but also influenced by raised central venous pressure. Ventilation and PEEP promulgate further physiological derangement. In theory, avoiding these physiological disturbances in a rested lung may be better for the lung and other organs. An alternative to positive pressure ventilation might be to investigate oxygen supplementation of a physiologically neutral and rested lung. Abandoning heroic ventilation would be a massive departure from current practice but might be a more rationale approach to future practice.
Collapse
Affiliation(s)
- N Soni
- Imperial College Medical School, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
| | | |
Collapse
|
23
|
Pulletz S, Elke G, Zick G, Schädler D, Scholz J, Weiler N, Frerichs I. Performance of electrical impedance tomography in detecting regional tidal volumes during one-lung ventilation. Acta Anaesthesiol Scand 2008; 52:1131-9. [PMID: 18840115 DOI: 10.1111/j.1399-6576.2008.01706.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electrical impedance tomography (EIT) is becoming a new medical imaging modality for continuous monitoring of regional lung function in the intensive care unit or operating room. The aim of our study was to evaluate the performance of EIT in detecting regional tidal volumes in patients during volume-controlled mechanical ventilation of one or both lungs. METHODS Ten adult patients undergoing elective thoracic surgery were included. EIT measurements were performed with the Goe-MF II EIT system. Data were collected before surgery during ventilation of both, the right and left lungs. Tidal volumes of 800 and 400 ml were applied during bilateral and unilateral ventilation, respectively. RESULTS Ventilation-related impedance changes determined in the whole chest cross-section during the right and left lung ventilation did not significantly differ from each other and were equal to 47.6+/-5.6% and 48.5+/-7.8% (mean+/-SD) of the value determined during bilateral ventilation. During unilateral ventilation, EIT clearly separated the ventilated and non-ventilated lung regions; nevertheless, ventilation-related impedance changes were also detected at the non-ventilated sides in areas corresponding to 3.4+/-4.1% and 12.4+/-6.9% of the scan halves during ventilation of the left and right lung, respectively. Changes in global tidal volumes were adequately detected by EIT during both bilateral and unilateral lung ventilation. CONCLUSION Although good separation of the ventilated and non-ventilated sides of the chest was possible, the data indicate that reliable quantification of regional tidal volumes during asymmetric or inhomogeneous distribution patterns requires regions-of-interest analysis.
Collapse
Affiliation(s)
- S Pulletz
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | | | | | | | | | | | | |
Collapse
|
24
|
García Fernández J. [Mechanical ventilation: learning from neonates]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:1-3. [PMID: 18333379 DOI: 10.1016/s0034-9356(08)70490-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
25
|
Hinz J, Hahn G, Quintel M. [Electrical impedance tomography: ready for routine clinical use for mechanically ventilated patients?]. Anaesthesist 2007; 57:61-9. [PMID: 17934702 DOI: 10.1007/s00101-007-1273-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Electrical impedance tomography (EIT) is a non-invasive, radiation-free functional imaging technique, which offers the possibility of continuous bedside measurement of regional lung ventilation. The principle of EIT is based on the input of alternating current and voltage measurement via surface electrodes placed around the thorax, which measure changes of electrical impedance parallel to changes in aeration within the lungs. This enables the measurement of regional ventilation. Because of the rapid time resolution of this technique, it can be used for the measurement of fast physiological effects. For more than 20 years EIT has been intensively used for research purposes, but has not yet been used for the monitoring of regional lung function in the routine clinical setting. This review describes the status of EIT in the clinical routine, its possibilities and limitations.
Collapse
Affiliation(s)
- J Hinz
- Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität, Robert-Koch-Str. 40, 37099 Göttingen, Deutschland.
| | | | | |
Collapse
|
26
|
Hinz J, Gehoff A, Moerer O, Frerichs I, Hahn G, Hellige G, Quintel M. Regional filling characteristics of the lungs in mechanically ventilated patients with acute lung injury. Eur J Anaesthesiol 2007; 24:414-24. [PMID: 17087844 DOI: 10.1017/s0265021506001517] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The objective of the study was to determine regional pulmonary filling characteristics in 20 mechanically ventilated patients with acute lung injury. METHODS Regional filling characteristics were calculated from tracings of regional tidal volumes vs. global tidal volumes measured by electrical impedance tomography (EIT). These plots were fitted to a polynomial function of the second degree. Regional polynomial coefficients of the second degree characterized the curve linearity of the plots. Near-zero values of the polynomial coefficient indicated a homogeneous increase in regional tidal volumes during the whole inspiration. Positive values hinted at initial low regional tidal volume change suggesting lung volume recruitment. Negative values indicated late low regional tidal volume change implying hyperinflation of this lung region. RESULTS We found a broad heterogeneity of regional lung filling characteristics. The minimal regional polynomial coefficients varied from -2.80 to -0.56 (median -1.16), while the maximal regional polynomial coefficients varied from 0.58 to 3.65 (median 1.41). CONCLUSIONS Measurements of regional filling characteristics by EIT may be a helpful tool to adjust the respiratory settings during mechanical ventilation to optimize lung recruitment and to avoid overdistension. It applies a non-pressure-related assessment to the mechanics of lung inflation and gives a view of the real problems underlying ventilatory strategies dependent on global characteristics.
Collapse
Affiliation(s)
- J Hinz
- University of Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany.
| | | | | | | | | | | | | |
Collapse
|