scholarly journals Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trial

2020 ◽  
Author(s):  
Jonas Weber ◽  
Jan Gutjahr ◽  
Johannes Schmidt ◽  
Sara Lozano-Zahonero ◽  
Silke Borgmann ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Profile Analysis ◽  
Intervention Group ◽  
Dynamic Strain ◽  
Control Group ◽  
Regional Ventilation ◽  
Impedance Tomography ◽  
Hemodynamic Variables

Abstract Background The application of positive end-expiratory pressure (PEEP) may reduce dynamic strain during mechanical ventilation. Although numerous approaches for PEEP titration have been proposed, there is no accepted strategy for titrating optimal PEEP. By analyzing intratidal compliance profiles, PEEP may be individually titrated for patients. Methods After obtaining informed consent, 60 consecutive patients undergoing general anesthesia were randomly allocated to mechanical ventilation with PEEP 5 cmH2O (control group) or PEEP individually titrated, guided by an analysis of the intratidal compliance profile (intervention group). The primary endpoint was the frequency of each nonlinear intratidal compliance (CRS) profile of the respiratory system (horizontal, increasing, decreasing, and mixed). The secondary endpoints measured were respiratory mechanics, hemodynamic variables, and regional ventilation, which was assessed via electrical impedance tomography. Results The frequencies of the CRS profiles were comparable between the groups. Besides PEEP [control: 5.0 (0.0), intervention: 5.8 (1.1) cmH2O, p < 0.001], the respiratory and hemodynamic variables were comparable between the two groups. The compliance profile analysis showed no significant differences between the two groups. The loss of ventral and dorsal regional ventilation was higher in the control [ventral: 41.0 (16.3)%; dorsal: 25.9 (13.8)%] than in the intervention group [ventral: 29.3 (17.6)%; dorsal: 16.4 (12.7)%; p (ventral) = 0.039, p (dorsal) = 0.028]. Conclusions Unfavorable compliance profiles indicating tidal derecruitment were found less often than in earlier studies. Individualized PEEP titration resulted in slightly higher PEEP. A slight global increase in aeration associated with this was indicated by regional gain and loss analysis. Differences in dorsal to ventral ventilation distribution were not found.

scholarly journals Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trial

2020 ◽  
Author(s):  
Jonas Weber ◽  
Jan Gutjahr ◽  
Johannes Schmidt ◽  
Sara Lozano-Zahonero ◽  
Silke Borgmann ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Profile Analysis ◽  
Intervention Group ◽  
Dynamic Strain ◽  
Control Group ◽  
Regional Ventilation ◽  
Impedance Tomography ◽  
Hemodynamic Variables

Abstract Background The application of positive end-expiratory pressure (PEEP) may reduce dynamic strain during mechanical ventilation. Although numerous approaches for PEEP titration have been proposed, there is no accepted strategy for titrating optimal PEEP. By analyzing intratidal compliance profiles, PEEP may be individually titrated for patients. Methods After obtaining informed consent, 60 consecutive patients undergoing general anesthesia were randomly allocated to mechanical ventilation with PEEP 5 cmH 2 O (control group) or PEEP individually titrated, guided by an analysis of the intratidal compliance profile (intervention group). The primary endpoint was the frequency of each nonlinear intratidal compliance (C RS ) profile of the respiratory system (horizontal, increasing, decreasing, and mixed). The secondary endpoints measured were respiratory mechanics, hemodynamic variables, and regional ventilation, which was assessed via electrical impedance tomography. Results The frequencies of the C RS profiles were comparable between the groups. Besides PEEP [control: 5.0 (0.0), intervention: 5.8 (1.1) cmH 2 O, p < 0.001], the respiratory and hemodynamic variables were comparable between the two groups. The compliance profile analysis showed no significant differences between the two groups. The loss of ventral and dorsal regional ventilation was higher in the control [ventral: 41.0 (16.3)%; dorsal: 25.9 (13.8)%] than in the intervention group [ventral: 29.3 (17.6)%; dorsal: 16.4 (12.7)%; p (ventral) = 0.039, p (dorsal) = 0.028]. Conclusions Unfavorable compliance profiles indicating tidal derecruitment were found less often than in earlier studies. Individualized PEEP titration resulted in slightly higher PEEP. A slight global increase in aeration associated with this was indicated by regional gain and loss analysis. Differences in dorsal to ventral ventilation distribution were not found.

scholarly journals Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trial

2019 ◽  
Author(s):  
Jonas Weber ◽  
Jan Gutjahr ◽  
Johannes Schmidt ◽  
Sara Lozano-Zahonero ◽  
Silke Borgmann ◽  
...  
Keyword(s):  
Respiratory System ◽  
Elective Surgery ◽  
Profile Analysis ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Regional Ventilation ◽  
Impedance Tomography ◽  
Randomized Controlled ◽  
Hemodynamic Variables

Abstract Background Application of positive end-expiratory pressure (PEEP) improves lung aeration and reduces mechanical stress during mechanical ventilation. Although numerous approaches for PEEP titration have been proposed, there is no accepted strategy to titrate optimal PEEP. By analyzing the intratidal compliance profiles, PEEP may be titrated patient-individually. Methods After obtaining informed consent, we measured respiratory system mechanics, regional ventilation in 60 consecutive patients undergoing elective surgery, randomly allocated to the control group (PEEP = 5 cmH 2 O) or the intervention group receiving individually titrated PEEP, guided by intratidal compliance profile analysis. Primary endpoint was the frequencies of nonlinear intratidal compliance (C RS ) profiles of the respiratory system (horizontal, increasing, decreasing and mixed). We further investigated respiratory and hemodynamic variables and regional ventilation. Results Frequencies of C RS profiles were comparable between the groups. Besides PEEP [control: 5.0 (0.0), intervention: 5.8 (1.1) cmH 2 O, p<0.001] respiratory and hemodynamic variables were comparable between the two groups. The compliance profile analysis showed no significant differences between the two groups. The loss of ventral and dorsal regional ventilation was higher in the control [ventral: 41.0 (16.3) %, dorsal: 25.9 (13.8) %] than in the intervention group [ventral: 29.3 (17.6) %, dorsal: 16.4 (12.7) %, p (ventral) = 0.039, p (dorsal) = 0.028]. Conclusions Individualized PEEP titration according to bedside compliance profile analysis improves regional ventilation in terms of global aeration gain without affecting respiratory and hemodynamic variables negatively and might be a promising approach to patient-individual ventilation settings. However, differences in dorsal to ventral ventilation distribution were not found. Unfavorable compliance profiles indicating tidal derecruitment were found less often than in earlier studies.

scholarly journals Individualized PEEP titration guided by intratidal compliance profile analysis improves regional ventilation – a randomized controlled trial

2019 ◽  
Author(s):  
Jonas Weber ◽  
Jan Gutjahr ◽  
Johannes Schmidt ◽  
Sara Lozano-Zahonero ◽  
Silke Borgmann ◽  
...  
Keyword(s):  
Respiratory System ◽  
Elective Surgery ◽  
Profile Analysis ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Regional Ventilation ◽  
Randomized Controlled ◽  
Hemodynamic Variables ◽  
Ventilation Setting

Abstract Background Application of positive end-expiratory pressure (PEEP) improves lung aeration and reduces mechanical stress during mechanical ventilation. Although numerous approaches for PEEP titration have been proposed, there is no accepted strategy to titrate optimal PEEP. By analyzing the intratidal compliance profiles, PEEP may be titrated patient-individually. Methods After obtaining informed consent, we measured respiratory system mechanics, regional ventilation in 60 consecutive patients undergoing elective surgery, randomly allocated to the control group (PEEP = 5 cmH2O) or the intervention group receiving individually titrated PEEP, guided by intratidal compliance profile analysis. Primary endpoint was the frequencies of nonlinear intratidal compliance (CRS) profiles of the respiratory system (horizontal, increasing, decreasing and mixed). We further investigated respiratory and hemodynamic variables and regional ventilation. Results Frequencies of CRS profiles were comparable between the groups. Besides PEEP [control: 5.0 (0.0), intervention: 5.8 (1.1) cmH2O, p<0.001] respiratory and hemodynamic variables were comparable between the two groups. The compliance profile analysis showed no significant differences between the two groups. The loss of ventral and dorsal regional ventilation was higher in the control [ventral: 41.0 (16.3) %, dorsal: 25.9 (13.9) %] than in the intervention group [ventral: 29.3 (17.6) %, dorsal: 16.4 (12.7) %, p (ventral) = 0.039, p (dorsal) = 0.028]. Conclusions Individualized PEEP titration according to bedside compliance profile analysis improves regional ventilation without affecting respiratory and hemodynamic variables negatively and may be a promising approach to patient-individual ventilation setting.

scholarly journals Individualized PEEP titration guided by intratidal compliance profile analysis improves regional ventilation – a randomized controlled trial

2019 ◽  
Author(s):  
Jonas Weber ◽  
Jan Gutjahr ◽  
Johannes Schmidt ◽  
Sara Lozano-Zahonero ◽  
Silke Borgmann ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Profile Analysis ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Ventilation Distribution ◽  
Regional Ventilation ◽  
Randomized Controlled ◽  
Hemodynamic Variables ◽  
Ventilation Setting

Abstract Background Application of positive end-expiratory pressure (PEEP) improves lung aeration and reduces mechanical stress during mechanical ventilation. Although numerous approaches for PEEP titration have been proposed, there is no accepted strategy to titrate optimal PEEP. By analyzing the intratidal compliance profiles, PEEP may be titrated patient-individually. Methods After obtaining informed consent, we measured respiratory system mechanics and regional ventilation in 60 consecutive patients undergoing elective surgery, randomly allocated to the control group (PEEP = 5 cmH 2 O) or the intervention group receiving individually titrated PEEP, guided by intratidal compliance profile analysis. Primary endpoint was the nonlinear intratidal compliance. We further investigated respiratory and hemodynamic variables, regional ventilation and compliance profiles. Results Compliance was comparable between control [63.2 (14.0) mL·cmH 2 O -1 ] and intervention group [67.8 (15.9) mL·cmH 2 O -1 , p = 0.271]. Besides PEEP [control: 5.0 (0.0), intervention: 5.8 (1.1) cmH 2 O] respiratory and hemodynamic variables were comparable between the two groups. The compliance profile analysis showed no significant differences between the two groups. Relative thoracic electrical impedance was better maintained in the intervention group (89.3 (19.4) %) than in the control group (78.3 (23.6) %, p < 0.001). No significant differences in dorsal to ventral ventilation distribution was found between the two groups. Conclusions Individualized PEEP titration according to bedside compliance profile analysis improves regional ventilation without affecting respiratory and hemodynamic variables negatively and may be a promising approach to patient-individual ventilation setting.

scholarly journals Determination of respiratory gas flow by electrical impedance tomography in an animal model of mechanical ventilation

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Marc Bodenstein ◽  
Stefan Boehme ◽  
Stephan Bierschock ◽  
Andreas Vogt ◽  
Matthias David ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Animal Model ◽  
Electrical Impedance Tomography ◽  
Gas Flow ◽  
Electrical Impedance ◽  
Impedance Tomography

What hinders pulmonary gas exchange and changes distribution of ventilation in immobilized white rhinoceroses (Ceratotherium simum) in lateral recumbency?

2020 ◽  
Vol 129 (5) ◽  
pp. 1140-1149
Author(s):  
Martina Mosing ◽  
Andreas D. Waldmann ◽  
Muriel Sacks ◽  
Peter Buss ◽  
Jordyn M. Boesch ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Breath Holding ◽  
Dependent Lung ◽  
Regional Ventilation ◽  
Impedance Tomography ◽  
Ventilation And Perfusion ◽  
Lateral Recumbency ◽  
Nondependent Lung

Electrical impedance tomography measurements of regional ventilation and perfusion applied to etorphine-immobilized white rhinoceroses in lateral recumbency revealed a pronounced disproportional shift of the measured ventilation and perfusion toward the nondependent lung. The dependent lung was minimally ventilated and perfused, but still aerated. Perfusion was found primarily around the hilum of the nondependent lung. These shifts can explain the gas exchange impairments found in this study. Breath holding can redistribute ventilation.

scholarly journals Electrical Impedance Tomography and Prone Position During Ventilation in COVID-19 Pneumonia: Case Reports and a Brief Literature Review

2020 ◽  
Vol 24 (4) ◽  
pp. 287-292
Author(s):  
Serena Tomasino ◽  
Rosa Sassanelli ◽  
Corrado Marescalco ◽  
Francesco Meroi ◽  
Luigi Vetrugno ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Literature Review ◽  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Case Reports ◽  
Prone Positioning ◽  
Impedance Tomography ◽  
Pneumonia Case ◽  
Different Types ◽  
Novel Coronavirus

At the end of 2019, a novel coronavirus (COVID-19) was identified as the cause of a cluster of pneumonia cases, with high needs of mechanical ventilation in critically ill patients. It is still unclear whether different types of COVID-19 pneumonia require different ventilator strategies. With electrical impedance tomography (EIT) we evaluated, in real time and bedside, the distribution of ventilation in the different pulmonary regions before, during, and after pronation in COVID-19 respiratory failure. We present a brief literature review of EIT in non-COVID-19 patients and a report of 2 COVID-19 patients: one that did not respond well and another one that improved during and after pronation. EIT might be a useful tool to decide whether prone positioning should or should not be used in COVID-19 pneumonia.

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