Electrical impedance tomography measured at two thoracic levels can visualize the ventilation distribution changes at the bedside during a decremental positive end-expiratory lung pressure trial

Critical Care

Diederik Gommers¹  Jan Bakker¹  Mahamud Egal¹  Carsten Preis²  Ido G Bikker¹ 

[1] Department of Intensive Care Medicine, Erasmus MC, 's-Gravendijkwal 230, NL-3015GE Rotterdam, The Netherlands;Department of Anesthesiology, Erasmus MC, 's-Gravendijkwal 230, NL-3015GE Rotterdam, The Netherlands

关键词: humans;    critical care;    atelectasis;    positive-pressure respiration;    mechanical ventilation;    electric impedance;   

Others  :  1094090
DOI  :  10.1186/cc10354

 received in 2010-10-01, accepted in 2011-08-11,  发布年份 2011

【 摘 要 】

Introduction

Computed tomography of the lung has shown that ventilation shifts from dependent to nondependent lung regions. In this study, we investigated whether, at the bedside, electrical impedance tomography (EIT) at the cranial and caudal thoracic levels can be used to visualize changes in ventilation distribution during a decremental positive end-expiratory pressure (PEEP) trial and the relation of these changes to global compliance in mechanically ventilated patients.

Methods

Ventilation distribution was calculated on the basis of EIT results from 12 mechanically ventilated patients after cardiac surgery at a cardiothoracic ICU. Measurements were taken at four PEEP levels (15, 10, 5 and 0 cm H₂O) at both the cranial and caudal lung levels, which were divided into four ventral-to-dorsal regions. Regional compliance was calculated using impedance and driving pressure data.

Results

We found that tidal impedance variation divided by tidal volume significantly decreased on caudal EIT slices, whereas this measurement increased on the cranial EIT slices. The dorsal-to-ventral impedance distribution, expressed according to the center of gravity index, decreased during the decremental PEEP trial at both EIT levels. Optimal regional compliance differed at different PEEP levels: 10 and 5 cm H₂O at the cranial level and 15 and 10 cm H₂O at the caudal level for the dependent and nondependent lung regions, respectively.

Conclusions

At the bedside, EIT measured at two thoracic levels showed different behavior between the caudal and cranial lung levels during a decremental PEEP trial. These results indicate that there is probably no single optimal PEEP level for all lung regions.

【 授权许可】

   
2011 Bikker et al.; licensee BioMed Central Ltd.

【 图 表 】

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