Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trial
Abstract Background The application of positive end-expiratory pressure (PEEP) may reduce dynamic strain during mechanical ventilation. Although numerous approaches for PEEP titration have been proposed, there is no accepted strategy for titrating optimal PEEP. By analyzing intratidal compliance pro...
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | BMC Anesthesiology |
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| Online Access: | http://link.springer.com/article/10.1186/s12871-020-00960-9 |
| _version_ | 1819038121177645056 |
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| author | Jonas Weber Jan Gutjahr Johannes Schmidt Sara Lozano-Zahonero Silke Borgmann Stefan Schumann Steffen Wirth |
| author_facet | Jonas Weber Jan Gutjahr Johannes Schmidt Sara Lozano-Zahonero Silke Borgmann Stefan Schumann Steffen Wirth |
| author_sort | Jonas Weber |
| collection | DOAJ |
| description | Abstract Background The application of positive end-expiratory pressure (PEEP) may reduce dynamic strain during mechanical ventilation. Although numerous approaches for PEEP titration have been proposed, there is no accepted strategy for titrating optimal PEEP. By analyzing intratidal compliance profiles, PEEP may be individually titrated for patients. Methods After obtaining informed consent, 60 consecutive patients undergoing general anesthesia were randomly allocated to mechanical ventilation with PEEP 5 cmH2O (control group) or PEEP individually titrated, guided by an analysis of the intratidal compliance profile (intervention group). The primary endpoint was the frequency of each nonlinear intratidal compliance (CRS) profile of the respiratory system (horizontal, increasing, decreasing, and mixed). The secondary endpoints measured were respiratory mechanics, hemodynamic variables, and regional ventilation, which was assessed via electrical impedance tomography. Results The frequencies of the CRS profiles were comparable between the groups. Besides PEEP [control: 5.0 (0.0), intervention: 5.8 (1.1) cmH2O, p < 0.001], the respiratory and hemodynamic variables were comparable between the two groups. The compliance profile analysis showed no significant differences between the two groups. The loss of ventral and dorsal regional ventilation was higher in the control [ventral: 41.0 (16.3)%; dorsal: 25.9 (13.8)%] than in the intervention group [ventral: 29.3 (17.6)%; dorsal: 16.4 (12.7)%; p (ventral) = 0.039, p (dorsal) = 0.028]. Conclusions Unfavorable compliance profiles indicating tidal derecruitment were found less often than in earlier studies. Individualized PEEP titration resulted in slightly higher PEEP. A slight global increase in aeration associated with this was indicated by regional gain and loss analysis. Differences in dorsal to ventral ventilation distribution were not found. Trial registration This clinical trial was registered at the German Register for Clinical Trials ( DRKS00008924 ) on August 10, 2015. |
| first_indexed | 2024-12-21T08:32:16Z |
| format | Article |
| id | doaj.art-ad4a04c431864780958f8fdfa5c411f4 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-21T08:32:16Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-ad4a04c431864780958f8fdfa5c411f42022-12-21T19:10:11ZengBMCBMC Anesthesiology1471-22532020-02-0120111010.1186/s12871-020-00960-9Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trialJonas Weber0Jan Gutjahr1Johannes Schmidt2Sara Lozano-Zahonero3Silke Borgmann4Stefan Schumann5Steffen Wirth6Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of FreiburgDepartment of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of FreiburgDepartment of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of FreiburgDepartment of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of FreiburgDepartment of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of FreiburgDepartment of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of FreiburgDepartment of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of FreiburgAbstract Background The application of positive end-expiratory pressure (PEEP) may reduce dynamic strain during mechanical ventilation. Although numerous approaches for PEEP titration have been proposed, there is no accepted strategy for titrating optimal PEEP. By analyzing intratidal compliance profiles, PEEP may be individually titrated for patients. Methods After obtaining informed consent, 60 consecutive patients undergoing general anesthesia were randomly allocated to mechanical ventilation with PEEP 5 cmH2O (control group) or PEEP individually titrated, guided by an analysis of the intratidal compliance profile (intervention group). The primary endpoint was the frequency of each nonlinear intratidal compliance (CRS) profile of the respiratory system (horizontal, increasing, decreasing, and mixed). The secondary endpoints measured were respiratory mechanics, hemodynamic variables, and regional ventilation, which was assessed via electrical impedance tomography. Results The frequencies of the CRS profiles were comparable between the groups. Besides PEEP [control: 5.0 (0.0), intervention: 5.8 (1.1) cmH2O, p < 0.001], the respiratory and hemodynamic variables were comparable between the two groups. The compliance profile analysis showed no significant differences between the two groups. The loss of ventral and dorsal regional ventilation was higher in the control [ventral: 41.0 (16.3)%; dorsal: 25.9 (13.8)%] than in the intervention group [ventral: 29.3 (17.6)%; dorsal: 16.4 (12.7)%; p (ventral) = 0.039, p (dorsal) = 0.028]. Conclusions Unfavorable compliance profiles indicating tidal derecruitment were found less often than in earlier studies. Individualized PEEP titration resulted in slightly higher PEEP. A slight global increase in aeration associated with this was indicated by regional gain and loss analysis. Differences in dorsal to ventral ventilation distribution were not found. Trial registration This clinical trial was registered at the German Register for Clinical Trials ( DRKS00008924 ) on August 10, 2015.http://link.springer.com/article/10.1186/s12871-020-00960-9PEEP titrationMechanical ventilationRespiratory system mechanicsGliding-SLICECompliance profile analysis |
| spellingShingle | Jonas Weber Jan Gutjahr Johannes Schmidt Sara Lozano-Zahonero Silke Borgmann Stefan Schumann Steffen Wirth Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trial BMC Anesthesiology PEEP titration Mechanical ventilation Respiratory system mechanics Gliding-SLICE Compliance profile analysis |
| title | Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trial |
| title_full | Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trial |
| title_fullStr | Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trial |
| title_full_unstemmed | Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trial |
| title_short | Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trial |
| title_sort | effect of individualized peep titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography a randomized controlled trial |
| topic | PEEP titration Mechanical ventilation Respiratory system mechanics Gliding-SLICE Compliance profile analysis |
| url | http://link.springer.com/article/10.1186/s12871-020-00960-9 |
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