Modern methods of assessment of lung aeration during mechanical ventilation.
Despite the fact that several modes of ventilation are being used, it is  not always possible to maintain adequate parameters of gas exchange. In  order to provide proper ventilation, it is necessary to assess the lung  function. The aim of this article is presentation of different methods  of assesment of lung aerations including its advantages, disadvantages  and  possibilities for implementation in clinical practice. Computed  tomography provides information regarding morphology and aeration of  lung tissue, but has several limitations: necessity of patients  transportation, it cannot be performed in a continuous manner, a  quantitative assessment of picture seems to be rather complicated.  Ultrasonography  is widely used in intensive care and is a noninvasive and bedside  method. It gives the opportunity to assess an investigated organ in real  time. Its clinical utility in patients with ARDS was proved by  Lichtenstein et al. Another technology which has been implemented for  the purpose of lungs visualization is electrobioimpedancy (EIT).  This new method consists of continuous monitoring of chest electrobioimpedancy changes due to its air content.  Unlike  to techniques mentioned above, lung images generated with EIT do not  provide any information about morphology of affected tissue. The method  which indirectly describes the sum of lung interactions is the  assessment of quasi-static P/V curve. This method provides information  allowing to draw conclusions regarding the usefulness of recruitment  maneuvers, but does not provide information regarding the nature of  morphologic changes and their location. In the search for the ideal  method of lung aeration assessment, it is necessary to define its  characteristics,  such as noninvasiveness, availability and visualization of tissue morphologic changes in real time.
Department of Anaesthesiology and Intensive Therapy, Praga Hospital, Warsaw, 00–195 Warszawa, Poland. wierzej@gmail.com
Wojciech
W
Wierzejski
Jan
J
Adamski
Wojciech
W
Weigl
Anna
A
Gerega
D017097:Electric Impedance; D006801:Humans; D008168:Lung / Q000502:physiology*; D012121:Respiration, Artificial; D014057:Tomography, X-Ray Computed