Electrical impedance tomography compared with thoracic computed tomography during a slow inflation maneuver in experimental models of lung injury*

Wrigge, Hermann; Zinserling, Jörg; Muders, Thomas; Varelmann, Dirk; Günther, Ulf; Groeben, Cornelius von der; Magnusson, Anders; Hedenstierna, Göran; Putensen, Christian

doi:10.1097/ccm.0b013e3181652edd

Cited by 184 publications

(165 citation statements)

References 30 publications

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“…As EIT is non-invasive and virtually causes no adverse side effects (lack of radiation, no transport required), the method has become an attractive alternative to computed tomography, magnetic resonance imaging or ultrasound examinations. Many comparative medical trials have proved that the EIT results are reliable and repeatable [21][22][23][24][25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Tomografia impedancyjna w diagnostyce i monitorowaniu zaburzeń funkcji płuc na oddziale intensywnej terapii — opis przypadku i przegląd piśmiennictwa

Białka

Copik

Rybczyk

et al. 2017

Anaesthesiol Intensive Ther

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The aim of this paper is to describe the possibility of using Electrical Impedance Tomography (EIT) as a treatment monitoring tool in the ICU. It was based on case report and literature review. A 19-year-old female was admitted to ICU due to severe acute respiratory distress syndrome. Despite aggressive treatment there was no improvement. We decided to use EIT in the monitoring of treatment because of difficulties in transporting the patient to the radiology department in order to perform a control CT scan. After identifying the causing factor (Pneumocyctis jiroveci), EIT monitoring was maintained to assess the effectiveness of targeted microbial treatment. In the following days, we observed an improvement of regional ventilation of the upper and middle segments of the left lung that corresponded well with laboratory test results, especially arterial blood gas analysis. The use of Electrical Impedance Tomography enables non-invasive, bedside, continuous assessment of regional lung ventilation. It is possible to use it in both mechanically ventilated and spontaneously breathing patients. It allows efficient and dynamic monitoring of the course of the therapeutic process. Interpretation of the results is relatively easy to learn and does not require specialist knowledge. Moreover, it is possible to use EIT in those cases where other methods are of high risk or contraindicated.

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Section: Discussionmentioning

confidence: 99%

Tomografia impedancyjna w diagnostyce i monitorowaniu zaburzeń funkcji płuc na oddziale intensywnej terapii — opis przypadku i przegląd piśmiennictwa

Białka

Copik

Rybczyk

et al. 2017

Anaesthesiol Intensive Ther

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“…Th ey found that the recruitment maneuver was more eff ective for opening collapsed alveoli in extrapulmonary compared to pulmonary ALI, improving lung mechanics and oxygenation with limited damage to alveolar epithelium. Using electrical impedance and computed tomography (CT) to assess lung ventilation and aeration, respectively, Wrigge et al [19] suggested that the distribution of regional ventilation was more heterogeneous in extrapulmonary than in pulmonary ALI during lung recruitment with slow inspiratory fl ow. However, this phenomenon and the claim that recruitment maneuvers are useful to protect the so called 'baby lung' , i.e., the lung tissue that is usually present in ventral areas and receives most of the tidal ventilation, has been recently challenged.…”

Section: Nature and Extent Of Lung Injurymentioning

confidence: 99%

New and Conventional Strategies for Lung Recruitment in Acute Respiratory Distress Syndrome

Pelosi¹,

Abreu²,

Rocco³

2010

Intensive Care Medicine

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This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. Pelosi et al. Critical Care 2010, 14:210 http://ccforum.com/content/14/2/210 © Springer-Verlag Berlin Heidelberg 2010. This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. recruitment maneuvers may also contribute to VILI [11,12], with translocation of pulmonary bacteria [13] and cytokines into the systemic circulation [14]. Furthermore, since recruitment maneuvers increase mean thoracic pressure, they may lead to a reduction in venous return with impairment of cardiac output [15]. R E V I E WVarious factors may infl uence the response to a recruitment maneuver, namely: 1) Th e nature and extent of lung injury, and 2) patient positioning. Nature and extent of lung injuryTh e nature of the underlying injury can aff ect the response to a recruitment maneuver. In direct (pulmonary) lung injury, the primary structure damaged is the alveolar epithelium resulting in alveolar fi lling by edema, fi brin, and neutrophilic aggregates. In indirect (extrapulmonary) lung injury, infl ammatory mediators are released from extrapulmonary foci into the systemic circulation leading to microvessel congestion and interstitial edema with relative sparing of intra-alveolar spaces [16]. Th erefore, recruitment maneuvers should be more eff ective to open atelectatic lung regions in indirect compared to direct lung injury. Based on this hypothesis, Kloot et al. [17] investigated the eff ects of recruitment maneuvers on gas exchange and lung volumes in three experimental models of ALI: Saline lavage or surfactant depletion, oleic acid, and pneumonia, and observed improvement in oxygenation only in ALI induced by surfactant depletion. Riva et al. [18] compared the eff ects of a recruitment maneuver in models of pulmonary and extrapulmonary ALI, induced by intratracheal and intraperitoneal instillation of Escherichia coli lipo polysaccharide, with similar transpulmonary pressures. Th ey found that the recruitment maneuver was more eff ective for opening collapsed alveoli in extrapulmonary compared to pulmonary ALI, improving lung mechanics and oxygenation with limited damage to alveolar epithelium. Using electrical imp...

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“…RVD has been shown to give accurate data during 12-mL/kg slow insufflation manoeuver by Wrigge [123], later confirmed by Muders [125]. In our case, the data were from spontaneously breathing patients, therefore we cannot know with certainty that the RVD index relates to cyclic opening and closing of the alveoli.…”

Section: Limitations Of the Studymentioning

confidence: 56%

“…Using TVar as one of EIT measures of ventilation distribution has been demonstrated by a number of studies [56,122,123] to provide valid information about the percentage of tidal volume in different parts of the lung.…”

Section: Introductionmentioning

confidence: 99%

“…It gives data on delayed opening of lung areas that have been previously unopened or collapsed. Thus, alveolar recruitment can be detected by EIT and expressed as a simple index [123,125]: the smaller the index, the smaller the delay. VSA and RVD calculations in this study slightly differ from these of Blankman [126] as results are presented in pixel values, rather than percentage.…”

Section: Introductionmentioning

confidence: 99%

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Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

Sutt¹

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Tracheostomised mechanically ventilated patients are often left unable to speak, which is frustrating for patients and the staff caring for them. Having no voice causes major distress and feelings of helplessness for patients. Voicelessness frequently leads to reduced information exchange between the patient and healthcare team, frequently to the detriment of patient care. An in-line speaking valve (SV) is a one-way valve that may be used in the mechanical ventilation circuit to enable verbal communication in tracheostomised patients.Limited data exist regarding the effect of SVs on respiratory mechanics. Deflation of the tracheostomy cuff is required for placement of the SV, effectively causing a "leak" in the As an experienced speech pathologist, I believe concerns over SV use to date have little evidence. The main objective, and first aim of this thesis was to investigate the effect of SV use on respiratory mechanics to determine whether SVs should be used in-line with mechanical ventilation of tracheostomised patients. The second aim was to assess the effect of introducing SVs into a cardio-thoracic ICU on patient tracheostomy specific outcomes. The third aim was to further clarify the effect of SVs on success with healthrelated communication for ICU patients. To achieve these aims, 5 studies were conducted, resulting in 5 manuscripts.For the first aim, 20 tracheostomised ICU patients using a SV that met the inclusion criteria were recruited to the study from November 2013-December 2014. Electrical Impedance iii Tomography (EIT) was used to assess the patients' end-expiratory lung impedance (EELI) and ventilation distribution continuously over 60 minutes (before, during and after SV use). For the third aim, 25 patients and 52 nursing staff were asked to fill out a custom-made questionnaire on success with health communication, firstly when the patients were voiceless, and, secondly, when they were using a SV. Chapter 7 highlights individual differences and some disparity between patient and nursing ratings of communication success. Overall, however, following SV use both the patients and nursing staff reported a significant improvement in success with health communication. Additional variables included oxygenation (SpOIn conclusion, the findings of this thesis addressed the research aims, and provide new knowledge through use of an innovative approach to assessing lung mechanics. Having iv already resulted in real clinical changes in our centre, the results indicate the potential for optimising communication, using SVs in tracheostomised cardiothoracic ICU patients undergoing weaning from mechanical ventilation.v

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Electrical impedance tomography compared with thoracic computed tomography during a slow inflation maneuver in experimental models of lung injury*

Cited by 184 publications

References 30 publications

Tomografia impedancyjna w diagnostyce i monitorowaniu zaburzeń funkcji płuc na oddziale intensywnej terapii — opis przypadku i przegląd piśmiennictwa

Tomografia impedancyjna w diagnostyce i monitorowaniu zaburzeń funkcji płuc na oddziale intensywnej terapii — opis przypadku i przegląd piśmiennictwa

New and Conventional Strategies for Lung Recruitment in Acute Respiratory Distress Syndrome

Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

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