Positive end-expiratory pressure titration at bedside using electrical impedance tomography in post-operative cardiac surgery patients

2015 ◽  
Vol 59 (6) ◽  
pp. 723-732 ◽  
Author(s):  
J. Karsten ◽  
C. Grusnick ◽  
H. Paarmann ◽  
M. Heringlake ◽  
H. Heinze
Keyword(s):  
Cardiac Surgery ◽  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Positive End Expiratory Pressure ◽  
Impedance Tomography

scholarly journals A Modified Method to Assess Tidal Recruitment by Electrical Impedance Tomography

2019 ◽  
Vol 8 (8) ◽  
pp. 1161 ◽  
Author(s):  
Thomas Muders ◽  
Benjamin Hentze ◽  
Philipp Simon ◽  
Felix Girrbach ◽  
Michael R.G. Doebler ◽  
...  
Keyword(s):  
Lung Injury ◽  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Characteristic Curve ◽  
Receiver Operator Characteristic Curve ◽  
Positive End Expiratory Pressure ◽  
Regional Ventilation ◽  
Impedance Tomography ◽  
Modified Method ◽  
Tidal Recruitment

Avoiding tidal recruitment and collapse during mechanical ventilation should reduce the risk of lung injury. Electrical impedance tomography (EIT) enables detection of tidal recruitment by measuring regional ventilation delay inhomogeneity (RVDI) during a slow inflation breath with a tidal volume (VT) of 12 mL/kg body weight (BW). Clinical applicability might be limited by such high VTs resulting in high end-inspiratory pressures (PEI) during positive end-expiratory pressure (PEEP) titration. We hypothesized that RVDI can be obtained with acceptable accuracy from reduced slow inflation VTs. In seven ventilated pigs with experimental lung injury, tidal recruitment was quantified by computed tomography at PEEP levels changed stepwise between 0 and 25 cmH2O. RVDI was measured by EIT during slow inflation VTs of 12, 9, 7.5, and 6 mL/kg BW. Linear correlation of tidal recruitment and RVDI was excellent for VTs of 12 (R2 = 0.83, p < 0.001) and 9 mL/kg BW (R2 = 0.83, p < 0.001) but decreased for VTs of 7.5 (R2 = 0.76, p < 0.001) and 6 mL/kg BW (R2 = 0.71, p < 0.001). With any reduction in slow inflation VT, PEI decreased at all PEEP levels. Receiver-Operator-Characteristic curve analyses revealed that RVDI-thresholds to predict distinct amounts of tidal recruitment differ when obtained from different slow inflation VTs. In conclusion, tidal recruitment can sufficiently be monitored by EIT-based RVDI-calculation with a slow inflation of 9 mL/kg BW.

Assessment of electrical impedance tomography to set optimal positive end-expiratory pressure for veno-venous ECMO-treated severe ARDS patients

2020 ◽  
Vol 60 ◽  
pp. 38-44 ◽  
Author(s):  
Floriane Puel ◽  
Laure Crognier ◽  
Christelle Soulé ◽  
Fanny Vardon-Bounes ◽  
Stéphanie Ruiz ◽  
...  
Keyword(s):  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Positive End Expiratory Pressure ◽  
Impedance Tomography

scholarly journals Positive End-Expiratory Pressure Setting in COVID-19-Related Acute Respiratory Distress Syndrome: Comparison Between Electrical Impedance Tomography, PEEP/FiO2 Tables, and Transpulmonary Pressure

2021 ◽  
Vol 8 ◽  
Author(s):  
Sébastien Gibot ◽  
Marie Conrad ◽  
Guilhem Courte ◽  
Aurélie Cravoisy
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Distress Syndrome ◽  
Invasive Technique ◽  
Positive End Expiratory Pressure ◽  
Impedance Tomography

Introduction: The best way to titrate the positive end-expiratory pressure (PEEP) in patients suffering from acute respiratory distress syndrome is still matter of debate. Electrical impedance tomography (EIT) is a non-invasive technique that could guide PEEP setting based on an optimized ventilation homogeneity.Methods: For this study, we enrolled the patients with 2019 coronavirus disease (COVID-19)-related acute respiratory distress syndrome (ARDS), who required mechanical ventilation and were admitted to the ICU in March 2021. Patients were monitored by an esophageal catheter and a 32-electrode EIT device. Within 48 h after the start of mechanical ventilation, different levels of PEEP were applied based upon PEEP/FiO2 tables, positive end-expiratory transpulmonary (PL)/ FiO2 table, and EIT. Respiratory mechanics variables were recorded.Results: Seventeen patients were enrolled. PEEP values derived from EIT (PEEPEIT) were different from those based upon other techniques and has poor in-between agreement. The PEEPEIT was associated with lower plateau pressure, mechanical power, transpulmonary pressures, and with a higher static compliance (Crs) and homogeneity of ventilation.Conclusion: Personalized PEEP setting derived from EIT may help to achieve a more homogenous distribution of ventilation. Whether this approach may translate in outcome improvement remains to be investigated.

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