Abstract P-578: ELECTRICAL IMPEDANCE TOMOGRAPHY: WHAT IS THE OPTIMAL PEEP IN CHILDREN WITH BRONCHIOLITIS?

Abstract

Aims & Objectives: Establishing the optimal PEEP in invasively ventilated patients is a challenge; the balance between collapse and over distension is difficult to assess and no method has been shown to prevent Ventilator Induced Lung Injury (VILI). Electrical Impedance Tomography (EIT) can be used to evaluate the regional compliance changes at different PEEP levels, measuring areas of collapse and over distention during a PEEP trial. Methods A PEEP trial analysis was performed using the Draeger Pulmovista 500 monitor using Draeger EIT Data Analysis tool 1.20. A decremental PEEP was applied (14/12/10/8/6/4 cmH2O) over a total of 10 minutes. The PEEP trial analysis tool shows areas of loss of compliance and over distention at higher PEEP, and areas of loss of compliance with collapse at lower PEEP. This tool will illustrate the physiologically optimal PEEP for each patient. Results 13 invasively ventilated children with a diagnosis of bronchiolitis were included; 15 PEEP trials were performed. The mean age was 1 month and weight 7.3 kg. The initial PEEP mean was 8.14, with an optimal PEEP mean of 8.63. The optimal PEEPs were different in 14/15 trials with an average difference of 1.95. There is seems to be an association between age and optimal PEEP given as Optimal PEEP = 9.1845 x age0.2482 (figure 1).Conclusions PEEP trial analysis using EIT can be an important tool to stablish the optimal PEEP in ventilated patients, avoiding the collapse/over distention associated with VILI. The technology is simple to use and analysis is straightforward.