scholarly journals Ventilation distribution measured with electrical impedance tomography at varying levels of assist during pressure support versus neurally adjusted ventilatory assist in ICU patients

Critical Care ◽  
2013 ◽  
Vol 17 (S2) ◽  
Author(s):  
MS Van Mourik ◽  
P Blankman ◽  
D Hasan ◽  
D Gommers
Keyword(s):  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Pressure Support ◽  
Neurally Adjusted Ventilatory Assist ◽  
Ventilation Distribution ◽  
Impedance Tomography ◽  
Icu Patients ◽  
Ventilatory Assist

Regional ventilation distribution determined by electrical impedance tomography: Reproducibility and effects of posture and chest plane

Respirology ◽  
2011 ◽  
Vol 16 (3) ◽  
pp. 523-531 ◽  
Author(s):  
FLORIAN REIFFERSCHEID ◽  
GUNNAR ELKE ◽  
SVEN PULLETZ ◽  
BARBARA GAWELCZYK ◽  
INGMAR LAUTENSCHLÄGER ◽  
...  
Keyword(s):  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Ventilation Distribution ◽  
Regional Ventilation ◽  
Impedance Tomography

Standardized Unloading of Respiratory Muscles during Neurally Adjusted Ventilatory Assist

2018 ◽  
Vol 129 (4) ◽  
pp. 769-777 ◽  
Author(s):  
Francesca Campoccia Jalde ◽  
Fredrik Jalde ◽  
Mats K. E. B. Wallin ◽  
Fernando Suarez-Sipmann ◽  
Peter J. Radell ◽  
...  
Keyword(s):  
Pressure Support ◽  
Respiratory Muscles ◽  
Lung Ventilation ◽  
Interquartile Range ◽  
Secondary Outcome ◽  
Neurally Adjusted Ventilatory Assist ◽  
Impedance Tomography ◽  
Respiratory Parameters ◽  
Ventilatory Parameters ◽  
Ventilatory Assist

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Currently, there is no standardized method to set the support level in neurally adjusted ventilatory assist (NAVA). The primary aim was to explore the feasibility of titrating NAVA to specific diaphragm unloading targets, based on the neuroventilatory efficiency (NVE) index. The secondary outcome was to investigate the effect of reduced diaphragm unloading on distribution of lung ventilation. Methods This is a randomized crossover study between pressure support and NAVA at different diaphragm unloading at a single neurointensive care unit. Ten adult patients who had started weaning from mechanical ventilation completed the study. Two unloading targets were used: 40 and 60%. The NVE index was used to guide the titration of the assist in NAVA. Electrical impedance tomography data, blood-gas samples, and ventilatory parameters were collected. Results The median unloading was 43% (interquartile range 32, 60) for 40% unloading target and 60% (interquartile range 47, 69) for 60% unloading target. NAVA with 40% unloading led to more dorsal ventilation (center of ventilation at 55% [51, 56]) compared with pressure support (52% [49, 56]; P = 0.019). No differences were found in oxygenation, CO2, and respiratory parameters. The electrical activity of the diaphragm was higher during NAVA with 40% unloading than in pressure support. Conclusions In this pilot study, NAVA could be titrated to different diaphragm unloading levels based on the NVE index. Less unloading was associated with greater diaphragm activity and improved ventilation of the dependent lung regions.

Spontaneous Breathing during General Anesthesia Prevents the Ventral Redistribution of Ventilation as Detected by Electrical Impedance Tomography

2012 ◽  
Vol 116 (6) ◽  
pp. 1227-1234 ◽  
Author(s):  
Oliver C. Radke ◽  
Thomas Schneider ◽  
Axel R. Heller ◽  
Thea Koch
Keyword(s):  
Laryngeal Mask Airway ◽  
General Anesthesia ◽  
Electrical Impedance Tomography ◽  
Pressure Support Ventilation ◽  
Spontaneous Breathing ◽  
Electrical Impedance ◽  
Pressure Support ◽  
Impedance Tomography ◽  
Support Ventilation ◽  
Pressure Controlled

Background Positive-pressure ventilation causes a ventral redistribution of ventilation. Spontaneous breathing during general anesthesia with a laryngeal mask airway could prevent this redistribution of ventilation. We hypothesize that, compared with pressure-controlled ventilation, spontaneous breathing and pressure support ventilation reduce the extent of the redistribution of ventilation as detected by electrical impedance tomography. Methods The study was a randomized, three-armed, observational, clinical trial without blinding. With approval from the local ethics committee, we enrolled 30 nonobese patients without severe cardiac or pulmonary comorbidities who were scheduled for elective orthopedic surgery. All of the procedures were performed under general anesthesia with a laryngeal mask airway and a standardized anesthetic regimen. The center of ventilation (primary outcome) was calculated before the induction of anesthesia (AWAKE), after the placement of the laryngeal mask airway (BEGIN), before the end of anesthesia (END), and after arrival in the postanesthesia care unit (PACU). Results The center of ventilation during anesthesia (BEGIN) was higher than baseline (AWAKE) in both the pressure-controlled and pressure support ventilation groups (pressure control: 55.0 vs. 48.3, pressure support: 54.7 vs. 48.8, respectively; multivariate analysis of covariance, P < 0.01), whereas the values in the spontaneous breathing group remained at baseline levels (47.9 vs. 48.5). In the postanesthesia care unit, the center of ventilation had returned to the baseline values in all groups. No adverse events were recorded. Conclusions Both pressure-controlled ventilation and pressure support ventilation induce a redistribution of ventilation toward the ventral region, as detected by electrical impedance tomography. Spontaneous breathing prevents this redistribution.

Sign in / Sign up

Export Citation Format

Share Document