Bedside Contribution of Electrical Impedance Tomography to Setting Positive End-Expiratory Pressure for Extracorporeal Membrane Oxygenation–treated Patients with Severe Acute Respiratory Distress Syndrome

Franchineau, Guillaume; Bréchot, Nicolas; Lebreton, Guillaume; Hékimian, Guillaume; Nieszkowska, Ania; Trouillet, Jean‐Louis; Leprince, Pascal; Chastre, Jean; Luyt, Charles‐Édouard; Combes, Alain; Schmidt, Matthieu

doi:10.1164/rccm.201605-1055oc

Cited by 129 publications

(113 citation statements)

References 41 publications

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“…At this time there are different views on the matter. Lachmann introduced the “open lung concept” applying higher levels of PEEP to keep the lungs open while others focus their ventilator settings on avoiding overdistension secondary to high PEEP levels, or define optimal PEEP as the lowest level of alveolar overdistension and collapse [19–22]. The PEEP level using a more open lung approach with CL less than 3 or 1% are presented as supplementary material.…”

Section: Discussionmentioning

confidence: 99%

“…The assessment of regional overdistension and atelectasis can be visualized using EIT during changes in PEEP and has been validated by histological examination of lung tissue [28]. An animal study used by Wolf et al was the first prospective study wherein EIT guided ventilator settings were used [18], followed by other animal and human studies [22, 29]. …”

Section: Discussionmentioning

confidence: 99%

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Clinical implementation of electric impedance tomography in the treatment of ARDS: a single centre experience

Heines

Strauch

Poll

et al. 2018

J Clin Monit Comput

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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 HO as clinically relevant. Changes in lung compliance and PaO/FiO-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 PaO/FiO-ratio. However, this increase was also observed in the group where the PEEP difference was less than 4 cm HO. 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical implementation of electric impedance tomography in the treatment of ARDS: a single centre experience

Heines

Strauch

Poll

et al. 2018

J Clin Monit Comput

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“…For example, assessing lung recruitability and optimizing PEEP at the individual patient level may translate in shorter duration of ECMO and respiratory support and even lower mortality [77].…”

Section: Physiologic Studies Evaluating Best Ventilation Strategies Imentioning

confidence: 99%

The ICM research agenda on extracorporeal life support

et al. 2017

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“…Nonetheless, recent studies tried to use EIT to map local pressure/volume curves to detect tidal recruitment and overdistension (56). Several EIT-based protocols have been proposed to guide the setting of PEEP during mechanical ventilation in ARDS, including patients receiving extracorporeal membrane lung oxygenation (57). However, the impact of these approaches on clinical outcome is not yet demonstrated.…”

Section: Eitmentioning

confidence: 99%

Lung imaging: how to get better look inside the lung

Ball¹,

Vercesi²,

Costantino³

et al. 2017

Ann. Transl. Med.

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In the last years, imaging has played a key role in the diagnosis and monitoring and critical illness, including acute respiratory distress syndrome (ARDS). Chest X-ray (CXR) and computed tomography (CT) are the conventional techniques most performed in the critically ill patients, the latter being the gold standard to assess lung aeration in ARDS patients. In addition, two bedside techniques are now gaining popularity alongside the conventional ones: lung ultrasound (LUS) and electrical impedance tomography (EIT). These techniques do not involve the use of ionizing radiations, are non-invasive and relatively easy to use, and are under extensive investigation as a complement, and for some application a substitution of conventional techniques. At last, positron emission tomography (PET) and magnetic resonance imaging (MRI) can provide functional information on the lung and respiratory function, and are increasingly used in research to improve the understanding of the pathophysiological mechanisms underlying ARDS. The purpose of this review is to give an up-to-date overview of the conventional and emerging imaging techniques available the diagnosis and management of patients with ARDS.

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Bedside Contribution of Electrical Impedance Tomography to Setting Positive End-Expiratory Pressure for Extracorporeal Membrane Oxygenation–treated Patients with Severe Acute Respiratory Distress Syndrome

Cited by 129 publications

References 41 publications

Clinical implementation of electric impedance tomography in the treatment of ARDS: a single centre experience

Clinical implementation of electric impedance tomography in the treatment of ARDS: a single centre experience

The ICM research agenda on extracorporeal life support

Lung imaging: how to get better look inside the lung

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