The online version of this article (https://doi.org/10.1007/s10877-018-0164-x) contains supplementary material, which is available to authorized users.
To report on our clinical experience using EIT in individualized PEEP titration in ARDS. Using EIT assessment, we optimized PEEP settings in 39 ARDS patients. The EIT PEEP settings were compared with the physicians’ PEEP settings and the PEEP settings according to the ARDS network. We defined a PEEP difference equal to or greater than 4 cm H2O as clinically relevant. Changes in lung compliance and PaO2/FiO2-ratio were compared in patients with EIT-based PEEP adjustments and in patients with unaltered PEEP. In 28% of the patients, the difference in EIT-based PEEP and physician-PEEP was clinically relevant; in 36%, EIT-based PEEP and physician-PEEP were equal. The EIT-based PEEP disagreed with the PEEP settings according to the ARDS network. Adjusting PEEP based upon EIT led to a rapid increase in lung compliance and PaO2/FiO2-ratio. However, this increase was also observed in the group where the PEEP difference was less than 4 cm H2O. We hypothesize that this can be attributed to the alveolar recruitment during the PEEP trial. EIT based individual PEEP setting appears to be a promising method to optimize PEEP in ARDS patients. The clinical impact, however, remains to be established.
Supplementary material 1 (XLSX 12 KB)10877_2018_164_MOESM1_ESM.xlsx
The Acute Respiratory Distress Syndrome Network Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–8. CrossRef
Kallet RH, Branson RD. Do the NIH ARDS clinical trials network PEEP/FiO 2 tables provide the best evidence-based guide to balancing PEEP and FiO 2 settings in adults? Respir Care. 2007;52(4):461–75.
Pelosi P, Ravagnan I, Giurati G, Panigada M, Bottino N, Tredici S, et al. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology. 1999;91(5):1221–31. CrossRef
Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med. 2008;178(4):346–55. CrossRef
Crotti S, Mascheroni D, Caironi P, Pelosi P, Ronzoni G, Mondino M, et al. Recruitment and derecruitment during acute respiratory failure: a clinical study. Am J Respir Crit Care Med. 2001;164(1):131–40. CrossRef
Pelosi P, Goldner M, McKibben A, Adams A, Eccher G, Caironi P, et al. Recruitment and derecruitment during acute respiratory failure: an experimental study. Am J Respir Crit Care Med. 2001;164(1):122–30. CrossRef
Pintado MC, de Pablo R, Trascasa M, Milicua JM, Rogero S, Daguerre M, et al. Individualized PEEP setting in subjects with ARDS: a randomized controlled pilot study. Respir Care. 2013;58(9):1416–23. CrossRef
Grasso S, Terragni P, Mascia L, Fanelli V, Quintel M, Herrmann P, et al. Airway pressure-time curve profile (stress index) detects tidal recruitment/hyperinflation in experimental acute lung injury. Crit Care Med. 2004;32(4):1018–27. CrossRef
Nestler C, Simon P, Petroff D, Hammermuller S, Kamrath D, Wolf S, et al. Individualized positive end-expiratory pressure in obese patients during general anaesthesia: a randomized controlled clinical trial using electrical impedance tomography. Br J Anaesth. 2017;119(6):1194–205. CrossRef
Eronia N, Mauri T, Maffezzini E, Gatti S, Bronco A, Alban L, et al. Bedside selection of positive end-expiratory pressure by electrical impedance tomography in hypoxemic patients: a feasibility study. Ann Intensive Care. 2017;7(1):76. CrossRef
Yun L, He HW, Moller K, Frerichs I, Liu D, Zhao Z. Assessment of lung recruitment by electrical impedance tomography and oxygenation in ARDS patients. Medicine (Baltimore). 2016;95(22):e3820. CrossRef
Blankman P, Shono A, Hermans BJ, Wesselius T, Hasan D, Gommers D. Detection of optimal PEEP for equal distribution of tidal volume by volumetric capnography and electrical impedance tomography during decreasing levels of PEEP in post cardiac-surgery patients. Br J Anaesth. 2016;116(6):862–9. CrossRef
He X, Jiang J, Liu Y, Xu H, Zhou S, Yang S, et al. Electrical impedance tomography-guided PEEP titration in patients undergoing laparoscopic abdominal surgery. Medicine (Baltimore). 2016;95(14):e3306. CrossRef
Long Y, Liu DW, He HW, Zhao ZQ. Positive end-expiratory pressure titration after alveolar recruitment directed by electrical impedance tomography. Chin Med J (Engl). 2015;128(11):1421–7. CrossRef
Spadaro S, Mauri T, Bohm SH, Scaramuzzo G, Turrini C, Waldmann AD, et al. Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment. Crit Care. 2018;22(1):26. CrossRef
Costa EL, Borges JB, Melo A, Suarez-Sipmann F, Toufen C Jr, Bohm SH, et al. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography. Intensive Care Med. 2009;35(6):1132–7. CrossRef
Force ADT, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–33.
Wolf GK, Gomez-Laberge C, Rettig JS, Vargas SO, Smallwood CD, Prabhu SP, et al. Mechanical ventilation guided by electrical impedance tomography in experimental acute lung injury. Crit Care Med. 2013;41(5):1296–304. CrossRef
Karsten J, Grusnick C, Paarmann H, Heringlake M, Heinze H. Positive end-expiratory pressure titration at bedside using electrical impedance tomography in post-operative cardiac surgery patients. Acta Anaesthesiol Scand. 2015;59(6):723–32. CrossRef
Papadakos PJ, Lachmann B. The open lung concept of alveolar recruitment can improve outcome in respiratory failure and ARDS. Mt Sinai J Med. 2002;69(1–2):73–7.
Retamal J, Bugedo G, Larsson A, Bruhn A. High PEEP levels are associated with overdistension and tidal recruitment/derecruitment in ARDS patients. Acta Anaesthesiol Scand. 2015;59(9):1161–9. CrossRef
Franchineau G, Brechot N, Lebreton G, Hekimian G, Nieszkowska A, Trouillet JL, et al. Bedside contribution of electrical impedance tomography to setting positive end-expiratory pressure for extracorporeal membrane oxygenation-treated patients with severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;196(4):447–57. CrossRef
Bikker IG, Leonhardt S, Reis Miranda D, Bakker J, Gommers D. 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. Crit Care. 2010;14(3):R100. CrossRef
Suarez-Sipmann F, Bohm SH, Tusman G, Pesch T, Thamm O, Reissmann H, et al. Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study. Crit Care Med. 2007;35(1):214–21. CrossRef
Lowhagen K, Lundin S, Stenqvist O. Regional intratidal gas distribution in acute lung injury and acute respiratory distress syndrome-assessed by electric impedance tomography. Minerva Anestesiol. 2010;76(12):1024–35.
Bikker IG, Leonhardt S, Bakker J, Gommers D. Lung volume calculated from electrical impedance tomography in ICU patients at different PEEP levels. Intensive Care Med. 2009;35(8):1362–7. CrossRef
Frerichs I, Amato MB, van Kaam AH, Tingay DG, Zhao Z, Grychtol B, et al. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax. 2016. https://doi.org/10.1136/thoraxjnl-2016-208357
Gomez-Laberge C, Rettig JS, Smallwood CD, Boyd TK, Arnold JH, Wolf GK. Interaction of dependent and non-dependent regions of the acutely injured lung during a stepwise recruitment manoeuvre. Physiol Meas. 2013;34(2):163–77. CrossRef
Hochhausen N, Biener I, Rossaint R, Follmann A, Bleilevens C, Braunschweig T, et al. Optimizing PEEP by electrical impedance tomography in a porcine animal model of ARDS. Respir Care. 2017;62(3):340–9. CrossRef
Karsten J, Stueber T, Voigt N, Teschner E, Heinze H. Influence of different electrode belt positions on electrical impedance tomography imaging of regional ventilation: a prospective observational study. Crit Care. 2016;20(1):3. CrossRef
Bikker IG, Preis C, Egal M, Bakker J, Gommers D. Electrical impedance tomography measured at two thoracic levels can visualize the ventilation distribution changes at the bedside during a decremental positive end-expiratory lung pressure trial. Crit Care. 2011;15(4):R193. CrossRef
- Clinical implementation of electric impedance tomography in the treatment of ARDS: a single centre experience
Serge J. H. Heines
Marcel C. G. van de Poll
Paul M. H. J. Roekaerts
Dennis C. J. J. Bergmans
- Springer Netherlands
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