Continuous noninvasive monitoring of lung recruitment during high-frequency oscillatory ventilation by electrical impedance measurement: an animal study.
BACKGROUND
Ventilatory pressures should target the range between the upper and lower inflection point of the pressure volume curve in order to avoid atelecto- and volutrauma. During high-frequency oscillatory ventilation (HFOV), this range is difficult to determine. Quadrant impedance measurement (QIM) has recently been shown to allow accurate and precise measurement of lung volume changes during conventional mechanical ventilation.


OBJECTIVE
To investigate if QIM can be used to determine a static pressure-residual impedance curve during a recruitment-derecruitment manoeuvre on HFOV and to monitor the time course of alveolar recruitment after changing mean airway pressure (MAP).


METHODS
An incremental and decremental MAP trial (6 cm H2O to 27 cm H2O) was conducted in five surfactant-depleted newborn piglets during HFOV. Ventilatory, gas exchange and haemodynamic parameters were recorded. Continuous measurement of thoracic impedance change was performed.


RESULTS
Mean residual impedance (RI) increased with each stepwise increase of MAP resulting in a total mean increase of +26.5% (±4.0) at the highest MAP (27 cm H2O) compared to baseline ventilation at 6 cm H2O. Upon decreasing MAP levels, RI fell more slowly compared to its ascent; 83.4% (±19.1) and 84.8% (±16.4) of impedance changes occurred in the first 5 min after an increase or decrease in airway pressure, respectively.


CONCLUSIONS
QIM could be used for continuous monitoring of thoracic impedance and determination of the pressure-RI curve during HFOV. The method could prove to be a promising bedside method for the monitoring of lung recruitment during HFOV in the future.
Department of Neonatology and Paediatric Intensive Care, University Hospital Carl Gustav Carus Dresden, Dresden, Germany.
Wolfram
W
Burkhardt
Florian
F
Kurth
Manuela
M
Pitterle
Nicola
N
Blassnig
Andreas
A
Wemhöner
Mario
M
Rüdiger
D000818:Animals; D000831:Animals, Newborn; D001784:Blood Gas Analysis; D017097:Electric Impedance; D006439:Hemodynamics; D006612:High-Frequency Ventilation; D008168:Lung / Q000502:physiology*; D008176:Lung Volume Measurements; D008991:Monitoring, Physiologic / Q000379:methods*; D011312:Pressure; D012123:Pulmonary Ventilation; D013552:Swine; D013997:Time Factors