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Effect of positive end-expiratory-pressure on regional ventilation in patients with acute lung injury evaluated by electrical impedance tomography

Published online by Cambridge University Press:  13 October 2005

J. Hinz ,
O. Moerer ,
P. Neumann ,
T. Dudykevych ,
G. Hellige  and
M. Quintel
J. Hinz
Affiliation:
University Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany
O. Moerer
Affiliation:
University Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany
P. Neumann
Affiliation:
University Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany
T. Dudykevych
Affiliation:
University Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany
G. Hellige
Affiliation:
University Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany
M. Quintel
Affiliation:
University Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany
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Extract

Summary

Background and objective: For the treatment of patients with adult respiratory distress syndrome and acute lung injury bedside measurements of regional lung ventilation should be considered for optimizing ventilatory settings. The aim was to investigate the effect of positive end-expiratory pressure (PEEP) on regional ventilation in mechanically ventilated patients at the bedside by electrical impedance tomography. Methods: Eight mechanically ventilated patients were included in the study. PEEP levels were increased from 0 to 5, 10, 15 mbar and back to 0 mbar. Regional ventilation in 912 regions of the thorax was investigated at each PEEP by electrical impedance tomography. The obtained regions were divided in four groups: none (none and poorly ventilated regions including chest wall and mediastinum), bad, moderate and well-ventilated regions. Results: Increasing the PEEP stepwise from 0 to 15 mbar decreased the non-ventilated regions (none: 540 regions at PEEP 0 and 406 regions at PEEP 15). In contrast, the other regions increased (bad: 316 regions at PEEP 0 and 380 regions at PEEP 15; moderate: 40 regions at PEEP 0 and 100 regions at PEEP 15; well: 0 region at PEEP 0 and 34 regions at PEEP 15 (median values)) indicating an improvement of regional ventilation. Conclusions: Increasing PEEP in mechanically ventilated patients reduces none ventilated regions (atelectasis). Furthermore, it leads to a shift from none and bad ventilated regions to moderately and well-ventilated regions. Electrical impedance tomography is a bedside technique and might be an alternative to computed tomography scan to assess aerated lung regions.

Keywords

THORACIC ELECTRICAL IMPEDANCE TOMOGRAPHY, regional ventilation, positive end-expiratory pressure
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 11 , November 2005 , pp. 817 - 825
Copyright
© 2005 European Society of Anaesthesiology

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References

Poulton EP. Left sided heart failure with pulmonary edema. Its treatment with the ‘pulmonary plus pressure machine’. Lancet 1936; 2: 981–994.Google Scholar
Ashbaugh DG, Petty TL, Bigelow DB, Harris TM. Continuous positive-pressure breathing (CPPB) in adult respiratory distress syndrome. J Thorac Cardiovasc Surg 1969; 57: 31–41.Google Scholar
Mancebo J. PEEP, ARDS, and alveolar recruitment. Intens Care Med 1992; 18: 383–385.Google Scholar
Suter PM, Fairley B, Isenberg MD. Optimum end-expiratory airway pressure in patients with acute pulmonary failure. New Engl J Med 1975; 292: 284–289.Google Scholar
Dammann JF, McAslan TC. PEEP: its use in young patients with apparently normal lungs. Crit Care Med 1979; 7: 14–19.Google Scholar
Kumar A, Falke KJ, Geffin B et al. Continuous positive-pressure ventilation in acute respiratory failure. New Engl J Med 1970; 283: 1430–1436.Google Scholar
Chapin JC, Downs JB, Douglas ME et al. Lung expansion, airway pressure transmission, and positive end-expiratory pressure. Arch Surg 1979; 114: 1193–1197.Google Scholar
Moreci AP, Norman JC. Measurements of alveolar sac diameters by incident-light photomicrography. Effects of positive-pressure respiration. Ann Thorac Surg 1973; 15: 179–186.Google Scholar
McIntyre RW, Laws AK, Ramachandran PR. Positive expiratory pressure plateau: improved gas exchange during mechanical ventilation. Can Anaesth Soc J 1969; 16: 477–486.Google Scholar
Katz JA, Ozanne GM, Zinn SE, Fairley HB. Time course and mechanisms of lung-volume increase with PEEP in acute pulmonary failure. Anesthesiology 1981; 54: 9–16.Google Scholar
Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 1998; 157: 294–323.Google Scholar
Gattinoni L, Pelosi P, Crotti S, Valenza F. Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med 1995; 151: 1807–1814.Google Scholar
Puybasset L, Gusman P, Muller JC et al. Regional distribution of gas and tissue in acute respiratory distress syndrome. III. Consequences for the effects of positive end-expiratory pressure. CT Scan ARDS Study Group. Adult Respiratory Distress Syndrome. Intens Care Med 2000; 26: 1215–1227.Google Scholar
Rouby JJ, Lu Q, Goldstein I. Selecting the right level of positive end-expiratory pressure in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2002; 165: 1182–1186.Google Scholar
Barber DC, Brown BH. Applied potential tomography. J Phys E Sci Instrum 1984; 17: 723–733.Google Scholar
Victorino JA, Borges JB, Okamoto VN et al. Imbalances in regional lung ventilation: a validation study on electrical impedance tomography. Am J Respir Crit Care Med 2004; 169: 791–800.Google Scholar
Adler A, Shinozuka N, Berthiaume Y et al. Electrical impedance tomography can monitor dynamic hyperinflation in dogs. J Appl Physiol 1998; 84: 726–732.Google Scholar
Adler A, Amyot R, Guardo R et al. Monitoring changes in lung air and liquid volumes with electrical impedance tomography. J Appl Physiol 1997; 83: 1762–1767.Google Scholar
Kunst PW, Bohm SH, de Vazquez A et al. Regional pressure volume curves by electrical impedance tomography in a model of acute lung injury. Crit Care Med 2000; 28: 178–183.Google Scholar
Kunst PW, de Vazquez A, Bohm SH et al. Monitoring of recruitment and derecruitment by electrical impedance tomography in a model of acute lung injury. Crit Care Med 2000; 28: 3891–3895.Google Scholar
Darling RC, Richards DW, Cournant A. Studies on intrapulmonary mixture of gases. Open circuit method for measuring residual air. J Clin Invest 1940; 19: 609–618.Google Scholar
Wrigge H, Sydow M, Zinserling J et al. Determination of functional residual capacity (FRC) by multibreath nitrogen washout in a lung model and in mechanically ventilated patients. Accuracy depends on continuous dynamic compensation for changes of gas sampling delay time. Intens Care Med 1998; 24: 487–493.Google Scholar
Barber DC, Seagar AD. Fast reconstruction of resistance images. Clin Phys Physiol Meas 1987; 8 (Suppl A): 47–54.Google Scholar
Frerichs I, Hinz J, Herrmann P et al. Detection of local lung air content by electrical impedance tomography compared with electron beam CT. J Appl Physiol 2002; 93: 660–666.Google Scholar
Hahn G, Sipinkova I, Baisch F, Hellige G. Changes in the thoracic impedance distribution under different ventilatory conditions. Physiol Meas 1995; 16: A161–A173.Google Scholar
Frerichs I. Electrical impedance tomography (EIT) in applications related to lung and ventilation: a review of experimental and clinical activities. Physiol Meas 2000; 21: R1–R21.Google Scholar
Hinz J, Neumann P, Dudykevych T et al. Regional ventilation by electrical impedance tomography – a comparison with ventilation scintigraphy in pigs. Chest 2003; 124: 314–322.Google Scholar
Arnold JH. Electrical impedance tomography: on the path to the holy grail. Crit Care Med 2004; 32: 894–895.Google Scholar
Hinz J, Hahn G, Neumann P et al. End-expiratory lung impedance change enables bedside monitoring of end-expiratory lung volume change. Intens Care Med 2003; 29: 37–43.Google Scholar
Wolf GK, Arnold JH. Noninvasive assessment of lung volume: respiratory inductance plethysmography and electrical impedance tomography. Crit Care Med 2005; 33: S163–S169.Google Scholar
Frerichs I, Schiffmann H, Oehler R et al. Distribution of lung ventilation in spontaneously breathing neonates lying in different body positions. Intens Care Med 2003; 29: 787–794.Google Scholar
Hahn G, Hartung C, Hellige G (1998) Bestimmung der Grösse minimal erfassbarer Areale mit Ventilationsstörungen. p. 77
Brown BH, Barber DC. Electrical impedance tomography: the construction and application to physiological measurement of electrical impedance images. Med Prog Technol 1987; 13: 69–75.Google Scholar
Koukourlis CS, Kyriacou GA, Sahalos JN. A 32-electrode data collection system for electrical impedance tomography. IEEE Trans Biomed Eng 1995; 42: 632–636.Google Scholar
Li JH, Joppek C, Faust U. Fast EIT data acquisition system with active electrodes and its application to cardiac imaging. Physiol Meas 1996; 17 (Suppl 4A): A25–A32.Google Scholar
Weisser G, Lehmann KJ, Scheck R et al. Performance of electron-beam CT: continuous-volume-scan compared to spiral CT. Radiologe 1998; 38: 993–998.Google Scholar
Weisser G, Lehmann KJ, Scheck R et al. Dose and image quality of electron-beam CT compared with spiral CT. Invest Radiol 1999; 34: 415–420.Google Scholar
Burch WM, Sullivan PJ, Lomas FE et al. Lung ventilation studies with technetium-99 m pseudogas. J Nucl Med 1986; 27: 842–846.Google Scholar
Wrigge H, Zinserling J, Neumann P et al. Spontaneous breathing improves lung aeration in oleic acid-induced lung injury. Anesthesiology 2003; 99: 376–384.Google Scholar
Faes TJ, van der Meij HA, de Munck JC, Heethaar RM. The electric resistivity of human tissues (100 Hz–10 MHz): a meta-analysis of review studies. Physiol Meas 1999; 20: R1–R10.Google Scholar
Wtorek J, Polinski A. The contribution of blood-flow-induced conductivity changes to measured impedance. IEEE Trans Biomed Eng 2005; 52: 41–49.Google Scholar
Hahn G, Frerichs I, Kleyer M, Hellige G. Local mechanics of the lung tissue determined by functional EIT. Physiol Meas 1996; 17 (Suppl 4A): A159–A166.Google Scholar
Hahn G, Thiel F, Dudykevych T et al. Quantitative evaluation of the performance of different electrical tomography devices. Biomed Tech (Berlin) 2001; 4: 91–95.Google Scholar
Lim CM, Soon LS, Seoung LJ et al. Morphometric effects of the recruitment manoeuvre on saline-lavaged canine lungs. A computed tomographic analysis. Anesthesiology 2003; 99: 71–80.Google Scholar
Hedenstierna G, Strandberg A, Brismar B et al. Functional residual capacity, thoracoabdominal dimensions, and central blood volume during general anesthesia with muscle paralysis and mechanical ventilation. Anesthesiology 1985; 62: 247–254.Google Scholar
Gattinoni L, D'Andrea L, Pelosi P et al. Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. JAMA 1993; 269: 2122–2127.Google Scholar
Frerichs I, Hahn G, Golisch W et al. Monitoring perioperative changes in distribution of pulmonary ventilation by functional electrical impedance tomography. Acta Anaesthesiol Scand 1998; 42: 721–726.Google Scholar