Non-invasive radiation-free monitoring of regional lung ventilation in critically ill infants

Frerichs, Inéz; Schiffmann, Holger; Hahn, G.; Hellige, G.

doi:10.1007/s001340101021

Cited by 86 publications

(69 citation statements)

References 23 publications

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“…It might be that the lung behaves different to positional change in the first hours after extubation to nCPAP. A previous report in a term born infant seems to support this hypothesis as ventilation distribution clearly shifted to the ventral region after placing this infant in prone position 1 h after extubation (15). Whether this shift in ventilation distribution to the ventral lung regions is consistent over time cannot be answered by this study.…”

Section: Discussionmentioning

confidence: 46%

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Changes in lung volume and ventilation following transition from invasive to noninvasive respiratory support and prone positioning in preterm infants

et al. 2014

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Section: Discussionmentioning

confidence: 46%

“…Furthermore, EIT also provides information on regional changes in volume and ventilation (12)(13)(14). Recent studies have shown that EIT is feasible in the preterm population and that the lung volume changes measures in the examined slice are representative for the whole lung (15)(16)(17).…”

mentioning

confidence: 99%

Changes in lung volume and ventilation following transition from invasive to noninvasive respiratory support and prone positioning in preterm infants

et al. 2014

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“…We did, however, find a significantly higher increase in Vosc in the right lung compared with the left lung. This right-sided predominance is probably best explained by the presence of the heart in the left hemithorax [21,26].…”

Section: Discussionmentioning

confidence: 99%

The effect of airway pressure and oscillation amplitude on ventilation in pre-term infants

Miedema

Jongh

Frerichs³

et al. 2012

Eur Respir J

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We determined the effect of lung recruitment and oscillation amplitude on regional oscillation volume and functional residual capacity (FRC) in high-frequency oscillatory ventilation (HFOV) used in pre-term infants with respiratory distress syndrome (RDS).Changes in lung volume, oscillation volume and carbon dioxide levels were recorded in 10 infants during a stepwise recruitment procedure, and an increase in pressure amplitude of 5 cmH 2 O was measured using electrical impedance tomography and transcutaneous monitoring. The pressures at maximal respiratory system compliance, maximal oscillation volume and minimal carbon dioxide levels were determined. Impedance data were analysed for the chest cross-section and predefined regions of interest.Despite the fixed pressure amplitude, the oscillation volume changed during the incremental pressure steps following a parabolic pattern, with an inverse relationship to the carbon dioxide pressures. The pressures corresponding with maximal compliance, maximal oscillation volume and minimal carbon dioxide were similar and highly correlated. Regional analysis showed similar findings. The increase in pressure amplitude resulted in increased oscillation volumes and decreased carbon dioxide levels, while FRC remained unchanged.In HFV pre-term infants with RDS, oscillation volumes are closely related to the position of ventilation in the pressure-volume envelope and the applied pressure amplitude. Changes in pressure amplitude do not seem to affect FRC.

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“…EIT has already been used to study adult [37,[42][43][44] and paediatric ARDS patients [27] as well neonatal patients suffering from respiratory distress syndrome [45,46]. The number of studied patients was rather low and EIT data were usually acquired only during short time intervals.…”

Section: The Value Of Eit In Monitoring Patients With Ardsmentioning

confidence: 99%

“…Although EIT monitoring lasting for several hours or days has been described in case reports [46] no long-term clinical studies using EIT have ever been performed. The reproducibility of EIT findings has also been documented only over rather short time intervals [68].…”

Section: The Limitations Of Eitmentioning

confidence: 99%

Electrical Impedance Tomography in Acute Respiratory Distress Syndrome

Frerichs¹,

Pulletz²,

Elke³

et al. 2010

TONMEDJ

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Electrical impedance tomography (EIT) is an emerging new imaging modality not yet routinely used in a clinical setting. The generation of EIT scans is based on the non-invasive measurement of electrical properties of tissues which does not require the use of radiation. Thoracic EIT examinations have been shown to track changes in regional lung volumes at scan rates of up to 40-50 scans/s. Experimental and clinical studies indicate the potential of EIT in monitoring regional lung ventilation and aeration at the bedside. Mechanically ventilated patients with acute lung injury and acute respiratory distress syndrome (ARDS) might benefit from possible continuous monitoring of their regional lung function by EIT which could be used to optimise the ventilator settings and minimise the ventilator-induced lung injury. This review explains the measuring principle of EIT and the analysis of regional EIT signals which allow the assessment of regional lung ventilation, aeration and potentially also lung perfusion. Protective lung ventilation using low tidal volumes and adequate positive end-expiratory pressures, recruitment manoeuvres, surfactant administration, prone posture, restricted fluid administration, assisted ventilation allowing spontaneous breathing, partial liquid ventilation, administration of pulmonary vasoactive, anti-inflammatory and antioxidant agents are used or considered in the management of ARDS patients. EIT is capable of monitoring the pulmonary effects of many of these therapeutic procedures. This is documented by examples from experimental and clinical EIT studies and by references to relevant EIT literature. The perspectives and limitations of EIT monitoring are also addressed.

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Non-invasive radiation-free monitoring of regional lung ventilation in critically ill infants

Abstract: Provided that EIT hardware and software are further developed to guarantee stable and undisturbed measurements in the ICU and that practical handling is improved, this non-invasive method may become a useful bedside monitoring tool of regional lung ventilation in critically ill infants.

Cited by 86 publications

References 23 publications

Changes in lung volume and ventilation following transition from invasive to noninvasive respiratory support and prone positioning in preterm infants

Changes in lung volume and ventilation following transition from invasive to noninvasive respiratory support and prone positioning in preterm infants

The effect of airway pressure and oscillation amplitude on ventilation in pre-term infants

Electrical Impedance Tomography in Acute Respiratory Distress Syndrome

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