Abstract
IntroductionAs it becomes clear that mechanical ventilation can exaggerate lung injury, individual titration of ventilator settings is of special interest. Electrical impedance tomography (EIT) has been proposed as a bedside, regional monitoring tool to guide these settings. In the present study we evaluate the use of ventilation distribution change maps (ΔfEIT maps) in intensive care unit (ICU) patients with or without lung disorders during a standardized decremental positive end-expiratory pressure (PEEP) trial.MethodsFunctional EIT (fEIT) images and PaO2/FiO2 ratios were obtained at four PEEP levels (15 to 10 to 5 to 0 cm H2O) in 14 ICU patients with or without lung disorders. Patients were pressure-controlled ventilated with constant driving pressure. fEIT images made before each reduction in PEEP were subtracted from those recorded after each PEEP step to evaluate regional increase/decrease in tidal impedance in each EIT pixel (ΔfEIT maps).ResultsThe response of regional tidal impedance to PEEP showed a significant difference from 15 to 10 (P = 0.002) and from 10 to 5 (P = 0.001) between patients with and without lung disorders. Tidal impedance increased only in the non-dependent parts in patients without lung disorders after decreasing PEEP from 15 to 10 cm H2O, whereas it decreased at the other PEEP steps in both groups.ConclusionsDuring a decremental PEEP trial in ICU patients, EIT measurements performed just above the diaphragm clearly visualize improvement and loss of ventilation in dependent and non-dependent parts, at the bedside in the individual patient.
Highlights
As it becomes clear that mechanical ventilation can exaggerate lung injury, individual titration of ventilator settings is of special interest
Mechanical ventilation is critical for the survival of most patients with respiratory failure admitted to the intensive care unit (ICU), but it has become clear that it can exaggerate lung damage and may even be the primary factor in lung injury [1]
In the present study we evaluate the use of ventilation distribution change maps in ICU patients with two distinct types of lung conditions: with or without lung disorders during a standardized decremental positive end-expiratory pressure (PEEP) trial
Summary
As it becomes clear that mechanical ventilation can exaggerate lung injury, individual titration of ventilator settings is of special interest. Protective ventilatory strategies to minimize this lung injury include reduction of tidal volume and prevention or minimization of lung collapse and Electrical impedance tomography (EIT) is a noninvasive, real-time imaging method that provides a crosssectional ventilation image of the lung [4,5,6]. It is based on the measurement of lung tissue impedance by injection of small currents and voltage measurements, using electrodes on the skin surface. As the clinically set PEEP is often guided by decremental PEEP trials, it would be of interest to evaluate the ventilation distribution change maps during this procedure
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