Distribution of Ventilation Measured by Electrical Impedance Tomography in Critically Ill Children

Inany, Hussam S; Rettig, Jordan S.; Smallwood, Craig D; Arnold, John H.; Walsh, Brian K

doi:10.4187/respcare.07076

Cited by 16 publications

(15 citation statements)

References 14 publications

(11 reference statements)

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“…In summary, these results, measured by a case-control trial with a crossover of two ventilation modes, revealed that EIS did not appear to reliably measure changes of impedance between NAVA and SIMV (PC) PS, when both, single and butterfly electrodes, are used in one study group. In addition, various studies have also shown a lack of comparison of ventilation modes by different methods [20,27,28].…”

Section: Discussionmentioning

confidence: 99%

Comparing ventilation modes by electrical impedance segmentography in ventilated children

Brandt

Mahlknecht

Werther

et al. 2022

J Clin Monit Comput

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Electrical impedance segmentography offers a new radiation-free possibility of continuous bedside ventilation monitoring. The aim of this study was to evaluate the efficacy and reproducibility of this bedside tool by comparing synchronized intermittent mandatory ventilation (SIMV) with neurally adjusted ventilatory assist (NAVA) in critically-ill children. In this prospective randomized case–control crossover trial in a pediatric intensive care unit of a tertiary center, including eight mechanically-ventilated children, four sequences of two different ventilation modes were consecutively applied. All children were randomized into two groups; starting on NAVA or SIMV. During ventilation, electric impedance segmentography measurements were recorded. The relative difference of vertical impedance between both ventilatory modes was measured (median 0.52, IQR 0–0.87). These differences in left apical lung segments were present during the first (median 0.58, IQR 0–0.89, p = 0.04) and second crossover (median 0.50, IQR 0–0.88, p = 0.05) as well as across total impedance (0.52 IQR 0–0.87; p = 0.002). During NAVA children showed a shift of impedance towards caudal lung segments, compared to SIMV. Electrical impedance segmentography enables dynamic monitoring of transthoracic impedance. The immediate benefit of personalized ventilatory strategies can be seen when using this simple-to-apply bedside tool for measuring lung impedance.

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Section: Discussionmentioning

confidence: 99%

Comparing ventilation modes by electrical impedance segmentography in ventilated children

Brandt

Mahlknecht

Werther

et al. 2022

J Clin Monit Comput

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“…e children's nutritional risks have not been screened in time. us, the malnutrition of critically ill children is neglected [10][11][12][13] X ± s). e horizontal axis from left to right represents before intervention and after intervention, and the vertical axis represents the IgG level (μmol/L).…”

Section: Discussionmentioning

confidence: 99%

Effect of Early Nutritional Assessment and Nutritional Support on Immune Function and Clinical Prognosis of Critically Ill Children

Jie

Jin

Cheng

et al. 2022

Journal of Healthcare Engineering

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The aim of this study was to study the effect of early nutritional assessment and nutritional support on immune function and clinical prognosis of critically ill children. 90 critically ill children at the same level of severity admitted to the pediatric intensive care unit (PICU) of our hospital (June 2019–June 2020) were chosen as the research objects and were equally separated into the experimental group and the control group by the random number table method. The children in the control group were admitted to the PICU according to the routine process, and the nutritional support was provided to the malnourished ones. After admission to the PICU, the children in the experimental group were given nutritional assessment, nutritional risk screening, and nutritional support according to the screening results. The PICU stay time and total hospitalization time of the experimental group were obviously shorter than those of the control group ( P < 0.05 ), the hospitalization expenses of the experimental group were obviously lower than those of the control group ( P < 0.05 ), the clinical outcomes and immune function of the experimental group were obviously better than those of the control group ( P < 0.05 ), and the nutrition indicators of the experimental group were obviously higher than those of the control group ( P < 0.05 ). Early nutritional assessment and nutritional support can effectively improve the immune function and reduce the incidence of adverse clinical outcomes of critically ill children, which are worthy of clinical application and promotion.

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“…12 The lower elastic recoil in children may further cause a shift to the more anterior parts of the lung. 29 Recently, Inay and colleagues reported 30 similar findings on the coefficient of variation in 25 children who had either CSV or no positive-pressure support. However, they also reported that under controlled ventilation the coefficient of variation was more directed toward the nondependent zones.…”

Section: Discussionmentioning

confidence: 78%

Global and Regional Tidal Volume Distribution in Spontaneously Breathing Mechanically Ventilated Children

et al. 2021

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BACKGROUND: Allowing the ventilated adult patient to breathe spontaneously may improve tidal volume (V T ) distribution toward the dependent lung regions, reduce shunt fraction, and decrease dead space. It has not been studied if these effects under various levels of ventilatory support also occur in children. We sought to explore the effect of level of ventilatory support on V T distribution and end-expiratory lung volume (EELV) in spontaneously breathing ventilated children in the recovery phase of their acute respiratory failure. METHODS: This is a secondary analysis of data from a prospective clinical trial comparing 2 different ventilator modes during weaning in mechanically ventilated children < 5 y CPAP + pressure support ventilation (PSV) and pressure control (PC)/intermittent mandatory ventilation (IMV) + PSV with the mandatory breath rate set at 25% of baseline. Using electrical impedance tomography (EIT), we assessed V T distribution by calculating the center of ventilation. Polynomial functions of the second degree were plotted to evaluate regional lung filling characteristics. Changes in end-expiratory impedance were calculated to assess changes in EELV. Baseline measurements were compared with measurements during CPAP/PSV, PC/IMV + PSV, and during a downward titration of the level of pressure support. RESULTS: Thirty-five subjects with a median age 4.5 (2.1-12.9) months and a median ventilation time of 4.9 (3.3-6.9) d were studied. The overall median coefficient of variation was 50.1% and not different between CPAP/PSV or PC/synchronized IMV + PSV. Regional filling characteristics of the lung identified a homogeneous V T distribution under all study conditions. Downtapering of the level of PSV resulted in a significant shift of the coefficient of variation toward the dependent lung regions. CONCLUSIONS: Our data showed that allowing ventilated children in the recovery phase of respiratory failure to breathe spontaneously in a continuous spontaneous ventilation mode did not negatively affect V T distribution or EELV.

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Distribution of Ventilation Measured by Electrical Impedance Tomography in Critically Ill Children

Cited by 16 publications

References 14 publications

Comparing ventilation modes by electrical impedance segmentography in ventilated children

Comparing ventilation modes by electrical impedance segmentography in ventilated children

Effect of Early Nutritional Assessment and Nutritional Support on Immune Function and Clinical Prognosis of Critically Ill Children

Global and Regional Tidal Volume Distribution in Spontaneously Breathing Mechanically Ventilated Children

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