K Lowhagen1, S Lundin, O Stenqvist. 1. Department of Anesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. karin.lowhagen@vgregion.se
Abstract
BACKGROUND: Regional tidal volume distribution and end-expiratory lung volume (EELV) distribution in patients with acute lung injury and acute respiratory distress syndrome (ALI, ARDS) have previously been investigated using computed tomograpy and electric impedance tomography (EIT). In the present study, we utilized the high temporal resolution of EIT to assess intratidal gas distribution. METHODS: Sixteen ventilator patients with ALI/ARDS were studied. EIT was used for analysis of intertidal, intratidal and EELV regional distribution. Intratidal regional gas distribution (ITV) was analyzed by dividing the regional tidal impedance signal into eight iso-volume parts. Alveolar pressure/volume curves during ongoing ventilation and volume-dependent compliance during the initial inspiration (Cini) were calculated. A low-pressure (~32 cm H2O) recruitment maneuver and a decremental PEEPtrial were implemented. RESULTS: The increase in EELV was preferentially distributed to non-dependent lung regions. The intratidal gas distribution pattern was similar to the tidal volume distribution following increased PEEP; non-dependent distribution decreased and dependent distribution increased during inspiration. Cini increased, indicating successful recruitment. The distribution varied widely among individual patients. In one patient with a low EELV, the ITV pattern showed that non-dependent distribution increased and dependent distribution decreased. This coincided with minimal improvement in volume-dependent compliance. This patient probably needed higher recruitment pressure. In one patient with a high baseline EELV, there was very little change in regional ITV, and non-dependent Cini decreased. This was probably a patient with low potential recruitability, who required only moderate PEEP. CONCLUSION: On-line intratidal gas distribution monitoring offers additional information on recruitability and optimal PEEP.
BACKGROUND: Regional tidal volume distribution and end-expiratory lung volume (EELV) distribution in patients with acute lung injury and acute respiratory distress syndrome (ALI, ARDS) have previously been investigated using computed tomograpy and electric impedance tomography (EIT). In the present study, we utilized the high temporal resolution of EIT to assess intratidal gas distribution. METHODS: Sixteen ventilator patients with ALI/ARDS were studied. EIT was used for analysis of intertidal, intratidal and EELV regional distribution. Intratidal regional gas distribution (ITV) was analyzed by dividing the regional tidal impedance signal into eight iso-volume parts. Alveolar pressure/volume curves during ongoing ventilation and volume-dependent compliance during the initial inspiration (Cini) were calculated. A low-pressure (~32 cm H2O) recruitment maneuver and a decremental PEEPtrial were implemented. RESULTS: The increase in EELV was preferentially distributed to non-dependent lung regions. The intratidal gas distribution pattern was similar to the tidal volume distribution following increased PEEP; non-dependent distribution decreased and dependent distribution increased during inspiration. Cini increased, indicating successful recruitment. The distribution varied widely among individual patients. In one patient with a low EELV, the ITV pattern showed that non-dependent distribution increased and dependent distribution decreased. This coincided with minimal improvement in volume-dependent compliance. This patient probably needed higher recruitment pressure. In one patient with a high baseline EELV, there was very little change in regional ITV, and non-dependent Cini decreased. This was probably a patient with low potential recruitability, who required only moderate PEEP. CONCLUSION: On-line intratidal gas distribution monitoring offers additional information on recruitability and optimal PEEP.
Authors: Adrian Regli; Rohan Mahendran; Edward T Fysh; Brigit Roberts; Bill Noffsinger; Bart L De Keulenaer; Bhajan Singh; Peter V van Heerden Journal: Crit Care Date: 2012-10-26 Impact factor: 9.097