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  • Muders, ThomasUniv Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53127 Bonn, Germany. (author)

Measurement of Electrical Impedance Tomography-Based Regional Ventilation Delay for Individualized Titration of End-Expiratory Pressure

  • Article/chapterEnglish2021

Publisher, publication year, extent ...

  • 2021-06-30
  • MDPI,2021
  • electronicrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:uu-451785
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-451785URI
  • https://doi.org/10.3390/jcm10132933DOI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

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  • Rationale: Individualized positive end-expiratory pressure (PEEP) titration might be beneficial in preventing tidal recruitment. To detect tidal recruitment by electrical impedance tomography (EIT), the time disparity between the regional ventilation curves (regional ventilation delay inhomogeneity [RVDI]) can be measured during controlled mechanical ventilation when applying a slow inflation of 12 mL/kg of body weight (BW). However, repeated large slow inflations may result in high end-inspiratory pressure (P-EI), which might limit the clinical applicability of this method. We hypothesized that PEEP levels that minimize tidal recruitment can also be derived from EIT-based RVDI through the use of reduced slow inflation volumes.Methods: Decremental PEEP trials were performed in 15 lung-injured pigs. The PEEP level that minimized tidal recruitment was estimated from EIT-based RVDI measurement during slow inflations of 12, 9, 7.5, or 6 mL/kg BW. We compared RVDI and P-EI values resulting from different slow inflation volumes and estimated individualized PEEP levels.Results: RVDI values from slow inflations of 12 and 9 mL/kg BW showed excellent linear correlation (R-2 = 0.87, p < 0.001). Correlations decreased for RVDI values from inflations of 7.5 (R-2 = 0.68, p < 0.001) and 6 (R-2 = 0.42, p < 0.001) mL/kg BW. Individualized PEEP levels estimated from 12 and 9 mL/kg BW were comparable (bias -0.3 cm H2O +/- 1.2 cm H2O). Bias and scatter increased with further reduction in slow inflation volumes (for 7.5 mL/kg BW, bias 0 +/- 3.2 cm H2O; for 6 mL/kg BW, bias 1.2 +/- 4.0 cm H2O). P-EI resulting from 9 mL/kg BW inflations were comparable with P-EI during regular tidal volumes.Conclusions: PEEP titration to minimize tidal recruitment can be individualized according to EIT-based measurement of the time disparity of regional ventilation courses during slow inflations with low inflation volumes(.) This sufficiently decreases P-EI and may reduce potential clinical risks.

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  • Hentze, BenjaminUniv Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53127 Bonn, Germany. (author)
  • Kreyer, StefanUniv Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53127 Bonn, Germany. (author)
  • Wodack, Karin HenrietteUniv Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53127 Bonn, Germany. (author)
  • Leonhardt, SteffenRhein Westfal TH Aachen, Chair Med Informat Technol, D-52074 Aachen, Germany. (author)
  • Hedenstierna, Göran,1941-Uppsala universitet,Klinisk fysiologi(Swepub:uu)goranhed (author)
  • Wrigge, HermannBergmannstrost Hosp Halle, Dept Anesthesiol Intens Care & Emergency Med, Pain Therapy, D-06112 Halle, Germany. (author)
  • Putensen, ChristianUniv Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53127 Bonn, Germany. (author)
  • Univ Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53127 Bonn, Germany.Rhein Westfal TH Aachen, Chair Med Informat Technol, D-52074 Aachen, Germany. (creator_code:org_t)

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  • In:Journal of Clinical Medicine: MDPI10:132077-0383

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