title: Dynamics of regional lung aeration determined by electrical impedance tomography in patients with acute respiratory distress syndrome.
abstract: BACKGROUND
  Lung tissue of patients with acute respiratory distress syndrome (ARDS) is heterogeneously damaged and prone to develop atelectasis. During inflation, atelectatic regions may exhibit alveolar recruitment accompanied by prolonged filling with air in contrast to regions with already open alveoli with a fast increase in regional aeration. During deflation, derecruitment of injured regions is possible with ongoing loss in regional aeration. The aim of our study was to assess the dynamics of regional lung aeration in mechanically ventilated patients with ARDS and its dependency on positive end-expiratory pressure (PEEP) using electrical impedance tomography (EIT).
  
  
  METHODS
  Twelve lung healthy and twenty ARDS patients were examined by EIT during sustained step increases in airway pressure from 0, 8 and 15 cm H2O to 35 cm H2O and during subsequent step decrease to the corresponding PEEP. Regional EIT waveforms in the ventral and dorsal lung regions were fitted to bi-exponential equations. Regional fast and slow respiratory time constants and the sizes of the fast and slow compartments were subsequently calculated.
  
  
  RESULTS
  ARDS patients exhibited significantly lower fast and slow time constants than the lung healthy patients in ventral and dorsal regions. The time constants were significantly affected by PEEP and differed between the regions. The size of the fast compartment was significantly lower in ARDS patients than in patients with healthy lung under all studied conditions.
  
  
  CONCLUSIONS
  These results show that regional lung mechanics can be assessed by EIT. They reflect the lower respiratory system compliance of injured lungs and imply more pronounced regional recruitment and derecruitment in ARDS patients.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Klinikum Osnabrück, Am Finkenhügel 1, 49076 Osnabrück, Germany. sven.pulletz@klinikum-os.de.
authors.forename: Sven
authors.initials: S
authors.lastname: Pulletz
authors.forename: Matthias
authors.initials: M
authors.lastname: Kott
authors.forename: Gunnar
authors.initials: G
authors.lastname: Elke
authors.forename: Dirk
authors.initials: D
authors.lastname: Schädler
authors.forename: Barbara
authors.initials: B
authors.lastname: Vogt
authors.forename: Norbert
authors.initials: N
authors.lastname: Weiler
authors.forename: Inéz
authors.initials: I
authors.lastname: Frerichs