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.
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.
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DOI：
10.1186/cc10354
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发表时间：
2011-08-11
期刊：
影响因子：
--
通讯作者：
Gommers D
中科院分区：
文献类型：
--
作者：
Bikker IG;Preis C;Egal M;Bakker J;Gommers D
肺的计算机断层扫描显示通气从依赖性肺区域转移到非依赖性肺区域。在这项研究中，我们调查了是否，在床边，电阻抗断层扫描（EIT）在头部和尾部胸部水平可以用来可视化的变化，通气分布在递减呼气末正压（PEEP）的试验和这些变化的关系，全球的机械通气患者的顺应性。根据心胸ICU心脏手术后12例机械通气患者的EIT结果计算通气分布。在四个PEEP水平（15，10，5和0 cm H2O）在头侧和尾侧肺水平，这被分为四个腹侧到背侧区域进行测量。使用阻抗和驱动压力数据计算区域顺应性。我们发现，潮气阻抗变化除以潮气量显着减少尾部EIT切片，而这个测量增加了头部EIT切片。根据重心指数表示的背腹阻抗分布在两个EIT水平的PEEP递减试验期间降低。不同PEEP水平下的最佳区域顺应性不同：对于依赖性和非依赖性肺区域，分别为头侧水平10和5 cm H2O以及尾侧水平15和10 cm H2O。在床旁，在两个胸部水平测量的EIT显示在递减PEEP试验期间尾侧和头侧肺水平之间的不同行为。这些结果表明，可能没有一个单一的最佳PEEP水平的所有肺区。
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. 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. 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. 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.
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DOI：
10.1186/cc9036
发表时间：
2010
期刊：
Critical care (London, England)
影响因子：
--
作者：
Bikker IG;Leonhardt S;Reis Miranda D;Bakker J;Gommers D
通讯作者：
Gommers D
影响因子：
3.2
作者：
Luepschen, H.;Meier, T.;Leonhardt, S.
通讯作者：
Leonhardt, S.
影响因子：
3.3
作者：
Hickling, Keith G
通讯作者：
Hickling, Keith G
影响因子：
38.9
作者：
Costa, Eduardo L. V.;Borges, Joao Batista;Amato, Marcelo B. P.
通讯作者：
Amato, Marcelo B. P.
影响因子：
8.8
作者：
Miranda, DR;Struijs, A;Gommers, D
通讯作者：
Gommers, D