Bedside measurement of changes in lung impedance to monitor alveolar ventilation in dependent and non-dependent parts by electrical impedance tomography during a positive end-expiratory pressure trial in mechanically ventilated intensive care unit patients.
BACKGROUND
As it becomes clear that mechanical ventilation can exaggerate lung injury, individual titration of ventilator settings is of special interest. Electrical impedance tomography (EIT) has been proposed as a bedside, regional monitoring tool to guide these settings. In the present study we evaluate the use of ventilation distribution change maps (DeltafEIT maps) in intensive care unit (ICU) patients with or without lung disorders during a standardized decremental positive end-expiratory pressure (PEEP) trial.


METHODS
Functional EIT (fEIT) images and PaO2/FiO2 ratios were obtained at four PEEP levels (15 to 10 to 5 to 0 cm H2O) in 14 ICU patients with or without lung disorders. Patients were pressure-controlled ventilated with constant driving pressure. fEIT images made before each reduction in PEEP were subtracted from those recorded after each PEEP step to evaluate regional increase/decrease in tidal impedance in each EIT pixel (DeltafEIT maps).


RESULTS
The response of regional tidal impedance to PEEP showed a significant difference from 15 to 10 (P = 0.002) and from 10 to 5 (P = 0.001) between patients with and without lung disorders. Tidal impedance increased only in the non-dependent parts in patients without lung disorders after decreasing PEEP from 15 to 10 cm H2O, whereas it decreased at the other PEEP steps in both groups.


CONCLUSIONS
During a decremental PEEP trial in ICU patients, EIT measurements performed just above the diaphragm clearly visualize improvement and loss of ventilation in dependent and non-dependent parts, at the bedside in the individual patient.
Bikker
Ido G
IG
Department of Intensive Care Medicine, Erasmus MC, 's-Gravendijkwal 230, Rotterdam, 3015 GE, The Netherlands. ig.bikker@gmail.com
Leonhardt
Steffen
S
Reis Miranda
Dinis
D
Bakker
Jan
J
Gommers
Diederik
D
D000368:Aged; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D019095:Point-of-Care Systems; D011175:Positive-Pressure Respiration; D011650:Pulmonary Alveoli / Q000502:physiology*; D012121:Respiration, Artificial; D014057:Tomography, X-Ray Computed / Q000379:methods*