Bedside measurement of changes in lung impedance to monitor alveolar ventilation in dependent and non-dependent parts by electrical impedance tomography during a positive end-expiratory pressure trial in mechanically ventilated inReportar como inadecuado




Bedside measurement of changes in lung impedance to monitor alveolar ventilation in dependent and non-dependent parts by electrical impedance tomography during a positive end-expiratory pressure trial in mechanically ventilated in - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Critical Care

, 14:R100

First Online: 30 May 2010Received: 26 November 2009Revised: 14 February 2010Accepted: 30 May 2010

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.

AbbreviationsCOPDChronic Obstructive Pulmonary Disease

CTcomputed tomography

EITElectrical Impedance Tomography

fEITfunctional EIT

ΔfEITfunctional EIT images subtracted pixelwise from each other

Group Dgroup with lung disorders

Group Ngroup without lung disorders

ICUintensive care unit

PEEPpositive end-expiratory pressure

ROIregion of interest

TIVtidal impedance variation

ΔZmpedance change.

Electronic supplementary materialThe online version of this article doi:10.1186-cc9036 contains supplementary material, which is available to authorized users.

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Autor: Ido G Bikker - Steffen Leonhardt - Dinis Reis Miranda - Jan Bakker - Diederik Gommers

Fuente: https://link.springer.com/



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