Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment
Abstract Background Assessing alveolar recruitment at different positive end-expiratory pressure (PEEP) levels is a major clinical and research interest because protective ventilation implies opening the lung without inducing overdistention. The pressure-volume (P-V) curve is a validated method of a...
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| Format: | Article |
| Language: | English |
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BMC
2018-01-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-017-1931-7 |
| _version_ | 1818229553709973504 |
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| author | Savino Spadaro Tommaso Mauri Stephan H. Böhm Gaetano Scaramuzzo Cecilia Turrini Andreas D. Waldmann Riccardo Ragazzi Antonio Pesenti Carlo Alberto Volta |
| author_facet | Savino Spadaro Tommaso Mauri Stephan H. Böhm Gaetano Scaramuzzo Cecilia Turrini Andreas D. Waldmann Riccardo Ragazzi Antonio Pesenti Carlo Alberto Volta |
| author_sort | Savino Spadaro |
| collection | DOAJ |
| description | Abstract Background Assessing alveolar recruitment at different positive end-expiratory pressure (PEEP) levels is a major clinical and research interest because protective ventilation implies opening the lung without inducing overdistention. The pressure-volume (P-V) curve is a validated method of assessing recruitment but reflects global characteristics, and changes at the regional level may remain undetected. The aim of the present study was to compare, in intubated patients with acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS), lung recruitment measured by P-V curve analysis, with dynamic changes in poorly ventilated units of the dorsal lung (dependent silent spaces [DSSs]) assessed by electrical impedance tomography (EIT). We hypothesized that DSSs might represent a dynamic bedside measure of recruitment. Methods We carried out a prospective interventional study of 14 patients with AHRF and ARDS admitted to the intensive care unit undergoing mechanical ventilation. Each patient underwent an incremental/decremental PEEP trial that included five consecutive phases: PEEP 5 and 10 cmH2O, recruitment maneuver + PEEP 15 cmH2O, then PEEP 10 and 5 cmH2O again. We measured, at the end of each phase, recruitment from previous PEEP using the P-V curve method, and changes in DSS were continuously monitored by EIT. Results PEEP changes induced alveolar recruitment as assessed by the P-V curve method and changes in the amount of DSS (p < 0.001). Recruited volume measured by the P-V curves significantly correlated with the change in DSS (r s = 0.734, p < 0.001). Regional compliance of the dependent lung increased significantly with rising PEEP (median PEEP 5 cmH2O = 11.9 [IQR 10.4–16.7] ml/cmH2O, PEEP 15 cmH2O = 19.1 [14.2–21.3] ml/cmH2O; p < 0.001), whereas regional compliance of the nondependent lung decreased from PEEP 5 cmH2O to PEEP 15 cmH2O (PEEP 5 cmH2O = 25.3 [21.3–30.4] ml/cmH2O, PEEP 15 cmH2O = 20.0 [16.6–22.8] ml/cmH2O; p <0.001). By increasing the PEEP level, the center of ventilation moved toward the dependent lung, returning to the nondependent lung during the decremental PEEP steps. Conclusions The variation of DSSs dynamically measured by EIT correlates well with lung recruitment measured using the P-V curve technique. EIT might provide useful information to titrate personalized PEEP. Trial registration ClinicalTrials.gov, NCT02907840. Registered on 20 September 2016. |
| first_indexed | 2024-12-12T10:20:26Z |
| format | Article |
| id | doaj.art-cd7134840a3e401f9f1a71554372fde1 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-12T10:20:26Z |
| publishDate | 2018-01-01 |
| publisher | BMC |
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| series | Critical Care |
| spelling | doaj.art-cd7134840a3e401f9f1a71554372fde12022-12-22T00:27:34ZengBMCCritical Care1364-85352018-01-012211910.1186/s13054-017-1931-7Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitmentSavino Spadaro0Tommaso Mauri1Stephan H. Böhm2Gaetano Scaramuzzo3Cecilia Turrini4Andreas D. Waldmann5Riccardo Ragazzi6Antonio Pesenti7Carlo Alberto Volta8Department of Morphology Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of FerraraDepartment of Anesthesia, Critical Care and Emergency, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Ca’ Granda, University of MilanEgalen GmbHDepartment of Morphology Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of FerraraDepartment of Morphology Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of FerraraSwisstom AGDepartment of Morphology Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of FerraraDepartment of Anesthesia, Critical Care and Emergency, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Ca’ Granda, University of MilanDepartment of Morphology Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of FerraraAbstract Background Assessing alveolar recruitment at different positive end-expiratory pressure (PEEP) levels is a major clinical and research interest because protective ventilation implies opening the lung without inducing overdistention. The pressure-volume (P-V) curve is a validated method of assessing recruitment but reflects global characteristics, and changes at the regional level may remain undetected. The aim of the present study was to compare, in intubated patients with acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS), lung recruitment measured by P-V curve analysis, with dynamic changes in poorly ventilated units of the dorsal lung (dependent silent spaces [DSSs]) assessed by electrical impedance tomography (EIT). We hypothesized that DSSs might represent a dynamic bedside measure of recruitment. Methods We carried out a prospective interventional study of 14 patients with AHRF and ARDS admitted to the intensive care unit undergoing mechanical ventilation. Each patient underwent an incremental/decremental PEEP trial that included five consecutive phases: PEEP 5 and 10 cmH2O, recruitment maneuver + PEEP 15 cmH2O, then PEEP 10 and 5 cmH2O again. We measured, at the end of each phase, recruitment from previous PEEP using the P-V curve method, and changes in DSS were continuously monitored by EIT. Results PEEP changes induced alveolar recruitment as assessed by the P-V curve method and changes in the amount of DSS (p < 0.001). Recruited volume measured by the P-V curves significantly correlated with the change in DSS (r s = 0.734, p < 0.001). Regional compliance of the dependent lung increased significantly with rising PEEP (median PEEP 5 cmH2O = 11.9 [IQR 10.4–16.7] ml/cmH2O, PEEP 15 cmH2O = 19.1 [14.2–21.3] ml/cmH2O; p < 0.001), whereas regional compliance of the nondependent lung decreased from PEEP 5 cmH2O to PEEP 15 cmH2O (PEEP 5 cmH2O = 25.3 [21.3–30.4] ml/cmH2O, PEEP 15 cmH2O = 20.0 [16.6–22.8] ml/cmH2O; p <0.001). By increasing the PEEP level, the center of ventilation moved toward the dependent lung, returning to the nondependent lung during the decremental PEEP steps. Conclusions The variation of DSSs dynamically measured by EIT correlates well with lung recruitment measured using the P-V curve technique. EIT might provide useful information to titrate personalized PEEP. Trial registration ClinicalTrials.gov, NCT02907840. Registered on 20 September 2016.http://link.springer.com/article/10.1186/s13054-017-1931-7Pressure-volume curveElectrical impedance tomographyAcute respiratory failureAcute respiratory distress syndromePersonalized medicinePositive end-expiratory pressure |
| spellingShingle | Savino Spadaro Tommaso Mauri Stephan H. Böhm Gaetano Scaramuzzo Cecilia Turrini Andreas D. Waldmann Riccardo Ragazzi Antonio Pesenti Carlo Alberto Volta Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment Critical Care Pressure-volume curve Electrical impedance tomography Acute respiratory failure Acute respiratory distress syndrome Personalized medicine Positive end-expiratory pressure |
| title | Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment |
| title_full | Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment |
| title_fullStr | Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment |
| title_full_unstemmed | Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment |
| title_short | Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment |
| title_sort | variation of poorly ventilated lung units silent spaces measured by electrical impedance tomography to dynamically assess recruitment |
| topic | Pressure-volume curve Electrical impedance tomography Acute respiratory failure Acute respiratory distress syndrome Personalized medicine Positive end-expiratory pressure |
| url | http://link.springer.com/article/10.1186/s13054-017-1931-7 |
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