title: Electrical impedance tomography-guided prone positioning in a patient with acute cor pulmonale associated with severe acute respiratory distress syndrome.
abstract: Electrical impedance tomography (EIT) is a noninvasive technique used to assess regional gas distribution in the lung. We experienced a patient with acute cor pulmonale during high positive-pressure ventilation for the treatment of severe acute respiratory distress syndrome. Prone positioning was beneficial for unloading the right ventricle for treatment of acute cor pulmonale. EIT played a role in detecting lung derecruitment at the patient's bedside. Impedance distribution in ventral, mid-ventral, mid-dorsal, and dorsal layers before and 20 min after the start of prone positioning was 9, 48, 44, and 0 %, and 10, 25, 48, and 16 %, respectively. Lung recruitment monitored by EIT paralleled the improvement of PaO2/FIO2 from 123 to 239 mmHg. Timing of termination of prone positioning and ventilator settings such as lowering positive end-expiration pressure was determined to maintain dorsal recruitment as seen by EIT. The patient was weaned from mechanical ventilation on day 32 and discharged on day 200. EIT assessed the effects of prone positioning with real-time dynamic imaging and guided less injurious mechanical ventilation in a patient with acute cor pulmonale with dorsal lung derecruitment.
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. tkotani@anes.twmu.ac.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Kotani
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tanabe
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, 162-8666, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yusa
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, 162-8666, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Saito
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, 162-8666, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamazaki
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ozaki
mesh_terms: D000368:Aged; D017097:Electric Impedance; D005260:Female; D006801:Humans; D011175:Positive-Pressure Respiration / Q000379:methods*; D016684:Prone Position; D011660:Pulmonary Heart Disease / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D014054:Tomography / Q000379:methods*
keywords: Acute cor pulmonale; Acute respiratory distress syndrome; Electrical impedance tomography; Prone positioning