Head-of-Bed Elevation Improves End-Expiratory Lung Volumes in Mechanically Ventilated Subjects: A Prospective Observational Study

Spooner, Amy J.; Corley, Amanda; Sharpe, Nicola A; Barnett, Adrian; Caruana, Lawrence R.; Hammond, Naomi; Fraser, John F.

doi:10.4187/respcare.02733

Cited by 26 publications

(36 citation statements)

References 32 publications

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“…25 EIT has been used to evaluate whether global and regional end-expiratory lung volumes improve by the degree of elevation. Spooner et al 26 found that head-of-bed elevation increases end-expiratory lung volumes and recommended, unless contraindicated, all mechanically ventilated patients should have their head of bed elevated. Figure 4 demonstrates the improvements in impedance by regions and the degree of elevation.…”

Section: Effects Of Position Changesmentioning

confidence: 99%

Electrical Impedance Tomography During Mechanical Ventilation

Walsh

Smallwood

2016

Respir Care

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Electrical impedance tomography (EIT) is a noninvasive, non-radiologic imaging modality that may be useful for the quantification of lung disorders and titration of mechanical ventilation. The principle of operation is based on changes in electrical conductivity that occur as a function of changes in lung volume during ventilation. EIT offers potentially important benefits over standard imaging modalities because the system is portable and non-radiologic and can be applied to patients for long periods of time. Rather than providing a technical dissection of the methods utilized to gather, compile, reconstruct, and display EIT images, the present article seeks to provide an overview of the clinical application of this technology as it relates to monitoring mechanical ventilation and providing decision support at the bedside. EIT has been shown to be useful in the detection of pneumothoraces, quantification of pulmonary edema and comparison of distribution of ventilation between different modes of ventilation and may offer superior individual titration of PEEP and other ventilator parameters compared with existing approaches. Although application of EIT is still primarily done within a research context, it may prove to be a useful bedside tool in the future. However, head-to-head comparisons with existing methods of mechanical ventilation titration in humans need to be conducted before its application in general ICUs can be recommended.

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Section: Effects Of Position Changesmentioning

confidence: 99%

Electrical Impedance Tomography During Mechanical Ventilation

Walsh

Smallwood

2016

Respir Care

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“…A limitation of time-differencing EIT is that it is unable to detect the pre-existing EELI [ 18 , 19 ], which means it can only detect changes in EELI if the device remains in situ and running between readings [ 15 , 18 – 20 ]. Researchers, however, have successfully used EIT to detect changes in EELI due to various clinical interventions such as suctioning, position change, and changes in PEEP [ 13 , 16 , 20 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

Speaking valves in tracheostomised ICU patients weaning off mechanical ventilation - do they facilitate lung recruitment?

et al. 2016

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BackgroundPatients who require positive pressure ventilation through a tracheostomy are unable to phonate due to the inflated tracheostomy cuff. Whilst a speaking valve (SV) can be used on a tracheostomy tube, its use in ventilated ICU patients has been inhibited by concerns regarding potential deleterious effects to recovering lungs. The objective of this study was to assess end expiratory lung impedance (EELI) and standard bedside respiratory parameters before, during and after SV use in tracheostomised patients weaning from mechanical ventilation.MethodsA prospective observational study was conducted in a cardio-thoracic adult ICU. 20 consecutive tracheostomised patients weaning from mechanical ventilation and using a SV were recruited. Electrical Impedance Tomography (EIT) was used to monitor patients’ EELI. Changes in lung impedance and standard bedside respiratory data were analysed pre, during and post SV use.ResultsUse of in-line SVs resulted in significant increase of EELI. This effect grew and was maintained for at least 15 minutes after removal of the SV (p < 0.001). EtCO2 showed a significant drop during SV use (p = 0.01) whilst SpO2 remained unchanged. Respiratory rate (RR (breaths per minute)) decreased whilst the SV was in situ (p <0.001), and heart rate (HR (beats per minute)) was unchanged. All results were similar regardless of the patients’ respiratory requirements at time of recruitment.ConclusionsIn this cohort of critically ill ventilated patients, SVs did not cause derecruitment of the lungs when used in the ventilator weaning period. Deflating the tracheostomy cuff and restoring the airflow via the upper airway with a one-way valve may facilitate lung recruitment during and after SV use, as indicated by increased EELI.Trial registrationAnna-Liisa Sutt, Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN: ACTRN12615000589583. 4/6/2015.

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“…As patient position has been shown to have an impact on ventilation distribution [101], we ensured that there were no significant changes in patient positioning throughout the data collection. A neonatal feeding catheter was inserted as described above and the pulse oximeter was positioned on the finger.…”

Section: Methodsmentioning

confidence: 99%

“…As transporting patients to radiology for CT is expensive and comes with increased risk [44,45], this was not an option. EIT, being a relatively new real-time radiation free bedside imaging tool [99][100][101][102], was found to be ideal in answering this key clinical question of whether patients' lungs are compromised when using SVs.…”

Section: Rationale and Significancementioning

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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Head-of-Bed Elevation Improves End-Expiratory Lung Volumes in Mechanically Ventilated Subjects: A Prospective Observational Study

Cited by 26 publications

References 32 publications

Electrical Impedance Tomography During Mechanical Ventilation

Electrical Impedance Tomography During Mechanical Ventilation

Speaking valves in tracheostomised ICU patients weaning off mechanical ventilation - do they facilitate lung recruitment?

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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