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Detection of ‘best’ positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial

INTRODUCTION: This study compares different parameters derived from electrical impedance tomography (EIT) data to define ‘best’ positive end-expiratory pressure (PEEP) during a decremental PEEP trial in mechanically-ventilated patients. ‘Best’ PEEP is regarded as minimal lung collapse and overdisten...

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Autores principales: Blankman, Paul, Hasan, Djo, Erik, Groot Jebbink, Gommers, Diederik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095609/
https://www.ncbi.nlm.nih.gov/pubmed/24887391
http://dx.doi.org/10.1186/cc13866
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author Blankman, Paul
Hasan, Djo
Erik, Groot Jebbink
Gommers, Diederik
author_facet Blankman, Paul
Hasan, Djo
Erik, Groot Jebbink
Gommers, Diederik
author_sort Blankman, Paul
collection PubMed
description INTRODUCTION: This study compares different parameters derived from electrical impedance tomography (EIT) data to define ‘best’ positive end-expiratory pressure (PEEP) during a decremental PEEP trial in mechanically-ventilated patients. ‘Best’ PEEP is regarded as minimal lung collapse and overdistention in order to prevent ventilator-induced lung injury. METHODS: A decremental PEEP trial (from 15 to 0 cm H(2)O PEEP in 4 steps) was performed in 12 post-cardiac surgery patients on the ICU. At each PEEP step, EIT measurements were performed and from this data the following were calculated: tidal impedance variation (TIV), regional compliance, ventilation surface area (VSA), center of ventilation (COV), regional ventilation delay (RVD index), global inhomogeneity (GI index), and intratidal gas distribution. From the latter parameter we developed the ITV index as a new homogeneity parameter. The EIT parameters were compared with dynamic compliance and the PaO(2)/FiO(2) ratio. RESULTS: Dynamic compliance and the PaO(2)/FiO(2) ratio had the highest value at 10 and 15 cm H(2)O PEEP, respectively. TIV, regional compliance and VSA had a maximum value at 5 cm H(2)O PEEP for the non-dependent lung region and a maximal value at 15 cm H(2)O PEEP for the dependent lung region. GI index showed the lowest value at 10 cm H(2)O PEEP, whereas for COV and the RVD index this was at 15 cm H(2)O PEEP. The intratidal gas distribution showed an equal contribution of both lung regions at a specific PEEP level in each patient. CONCLUSION: In post-cardiac surgery patients, the ITV index was comparable with dynamic compliance to indicate ‘best’ PEEP. The ITV index can visualize the PEEP level at which ventilation of the non-dependent region is diminished, indicating overdistention. Additional studies should test whether application of this specific PEEP level leads to better outcome and also confirm these results in patients with acute respiratory distress syndrome.
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spelling pubmed-40956092014-07-14 Detection of ‘best’ positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial Blankman, Paul Hasan, Djo Erik, Groot Jebbink Gommers, Diederik Crit Care Research INTRODUCTION: This study compares different parameters derived from electrical impedance tomography (EIT) data to define ‘best’ positive end-expiratory pressure (PEEP) during a decremental PEEP trial in mechanically-ventilated patients. ‘Best’ PEEP is regarded as minimal lung collapse and overdistention in order to prevent ventilator-induced lung injury. METHODS: A decremental PEEP trial (from 15 to 0 cm H(2)O PEEP in 4 steps) was performed in 12 post-cardiac surgery patients on the ICU. At each PEEP step, EIT measurements were performed and from this data the following were calculated: tidal impedance variation (TIV), regional compliance, ventilation surface area (VSA), center of ventilation (COV), regional ventilation delay (RVD index), global inhomogeneity (GI index), and intratidal gas distribution. From the latter parameter we developed the ITV index as a new homogeneity parameter. The EIT parameters were compared with dynamic compliance and the PaO(2)/FiO(2) ratio. RESULTS: Dynamic compliance and the PaO(2)/FiO(2) ratio had the highest value at 10 and 15 cm H(2)O PEEP, respectively. TIV, regional compliance and VSA had a maximum value at 5 cm H(2)O PEEP for the non-dependent lung region and a maximal value at 15 cm H(2)O PEEP for the dependent lung region. GI index showed the lowest value at 10 cm H(2)O PEEP, whereas for COV and the RVD index this was at 15 cm H(2)O PEEP. The intratidal gas distribution showed an equal contribution of both lung regions at a specific PEEP level in each patient. CONCLUSION: In post-cardiac surgery patients, the ITV index was comparable with dynamic compliance to indicate ‘best’ PEEP. The ITV index can visualize the PEEP level at which ventilation of the non-dependent region is diminished, indicating overdistention. Additional studies should test whether application of this specific PEEP level leads to better outcome and also confirm these results in patients with acute respiratory distress syndrome. BioMed Central 2014 2014-05-10 /pmc/articles/PMC4095609/ /pubmed/24887391 http://dx.doi.org/10.1186/cc13866 Text en Copyright © 2014 Blankman et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Blankman, Paul
Hasan, Djo
Erik, Groot Jebbink
Gommers, Diederik
Detection of ‘best’ positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial
title Detection of ‘best’ positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial
title_full Detection of ‘best’ positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial
title_fullStr Detection of ‘best’ positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial
title_full_unstemmed Detection of ‘best’ positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial
title_short Detection of ‘best’ positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial
title_sort detection of ‘best’ positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095609/
https://www.ncbi.nlm.nih.gov/pubmed/24887391
http://dx.doi.org/10.1186/cc13866
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