Regional lung ventilation and perfusion by electrical impedance tomography compared to single-photon emission computed tomography

Hentze, Benjamin; Muders, Thomas; Luepschen, Henning; Maripuu, Enn; Hedenstierna, Göran; Putensen, Christian; Walter, Marian; Leonhardt, Steffen

doi:10.1088/1361-6579/aac7ae

Cited by 25 publications

(30 citation statements)

References 42 publications

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“…PEEP, when set according to EIT, may aid in optimizing lung recruitment and homogeneity of ventilation [ 73 ]. Technological development by EIT may also quantitatively estimate regional lung perfusion based on first-pass kinetics of a bolus of hypertonic saline contrast [ 74 , 75 ]. To evaluate lung morphology and the potential for recruitment, ARDS patients should ideally undergo chest or lung imaging at different pressures.…”

Section: Introductionmentioning

confidence: 99%

Personalized mechanical ventilation in acute respiratory distress syndrome

et al. 2021

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A personalized mechanical ventilation approach for patients with adult respiratory distress syndrome (ARDS) based on lung physiology and morphology, ARDS etiology, lung imaging, and biological phenotypes may improve ventilation practice and outcome. However, additional research is warranted before personalized mechanical ventilation strategies can be applied at the bedside. Ventilatory parameters should be titrated based on close monitoring of targeted physiologic variables and individualized goals. Although low tidal volume (VT) is a standard of care, further individualization of VT may necessitate the evaluation of lung volume reserve (e.g., inspiratory capacity). Low driving pressures provide a target for clinicians to adjust VT and possibly to optimize positive end-expiratory pressure (PEEP), while maintaining plateau pressures below safety thresholds. Esophageal pressure monitoring allows estimation of transpulmonary pressure, but its use requires technical skill and correct physiologic interpretation for clinical application at the bedside. Mechanical power considers ventilatory parameters as a whole in the optimization of ventilation setting, but further studies are necessary to assess its clinical relevance. The identification of recruitability in patients with ARDS is essential to titrate and individualize PEEP. To define gas-exchange targets for individual patients, clinicians should consider issues related to oxygen transport and dead space. In this review, we discuss the rationale for personalized approaches to mechanical ventilation for patients with ARDS, the role of lung imaging, phenotype identification, physiologically based individualized approaches to ventilation, and a future research agenda.

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Section: Introductionmentioning

confidence: 99%

Personalized mechanical ventilation in acute respiratory distress syndrome

et al. 2021

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“…In order to validate our findings, we compared regional lung ventilation and perfusion from EIT using hypertonic saline (NaCl 10%, 10 mL) with SPECT at two different PEEP levels (0 and 15 cmH 2 O) [65]. While there has been a sufficient correlation between EIT and SPECT for both ventilation and perfusion, we observed a spatial mismatch between ventilation and perfusion which might spoil the pixel-wise calculation of regional V/Q.…”

Section: Perfusion Monitoringmentioning

confidence: 91%

“…A promising technique for EIT perfusion monitoring is the use of conductive contrast agents such as hypertonic saline (e.g., NaCl 5.85%, 10 mL) to obtain an EIT waveform (indicator-based signal, IBS). The contrast agent is injected into the bloodstream as a bolus through a CVC under short-time apnea [64,65] and follows the blood flow through the cardio-pulmonary system (Figure 5).…”

Section: Perfusion Monitoringmentioning

confidence: 99%

“…While the IBS has the advantage of being clearly linked to regional perfusion, disadvantages might result from the need for a CVC, short-time apnea as well as possible hemolysis due to the high osmolality of the contrast agents [66]. Currently, the method is established in animal research, but a reduction of the contrast agent concentration might enable a clinical application in patients in the near future [65,67].…”

Section: Perfusion Monitoringmentioning

confidence: 99%

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Electrical Impedance Tomography for Cardio-Pulmonary Monitoring

Putensen

Hentze

Muenster

et al. 2019

JCM

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106

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Electrical impedance tomography (EIT) is a bedside monitoring tool that noninvasively visualizes local ventilation and arguably lung perfusion distribution. This article reviews and discusses both methodological and clinical aspects of thoracic EIT. Initially, investigators addressed the validation of EIT to measure regional ventilation. Current studies focus mainly on its clinical applications to quantify lung collapse, tidal recruitment, and lung overdistension to titrate positive end-expiratory pressure (PEEP) and tidal volume. In addition, EIT may help to detect pneumothorax. Recent studies evaluated EIT as a tool to measure regional lung perfusion. Indicator-free EIT measurements might be sufficient to continuously measure cardiac stroke volume. The use of a contrast agent such as saline might be required to assess regional lung perfusion. As a result, EIT-based monitoring of regional ventilation and lung perfusion may visualize local ventilation and perfusion matching, which can be helpful in the treatment of patients with acute respiratory distress syndrome (ARDS).

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“…More and more evidence had shown contrast based-EIT method has the potential to quantitatively assess regional lung perfusion at various pathophysiologic conditions (such as PE, lung collapse, ARDS, response to PEEP change etc.) (1)(2)(3)(4)(5)(6). Further study is required to validate the impact of the described saline-based EIT method on decision making, therapeutic management and outcomes in critically ill patients.…”

Section: To the Editormentioning

confidence: 99%