Protective ventilation using electrical impedance tomography
Protective ventilation using electrical impedance tomography
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DOI：
10.1088/0967-3334/28/7/s18
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发表时间：
2007-07-01
影响因子：
3.2
通讯作者：
Leonhardt, S.
中科院分区：
文献类型：
--
作者：
Luepschen, H.;Meier, T.;Leonhardt, S.
动态胸部EIT能够检测肺中通气分布的变化。然而，它还没有成为一个成熟的临床工具。因此，有必要考虑应用场景，其中要发现组织电导率的快速和明显变化，并且还具有明确的诊断意义。一种这样的情况是患有急性呼吸窘迫综合征（ARDS）的患者的人工通气。新的保护性通气策略涉及复张策略，与体液和区域通气的明显变化相关，这可以很容易地被EIT检测到。这些招募策略的床边评估将有助于主治医生优化治疗。因此，我们进行了一项灌洗诱导的肺衰竭的动物研究，并研究了EIT是否能够在逐步PEEP试验中定性和定量监测肺复张。此外，我们将EIT集成到基于模糊呼吸机的通气系统中，该系统允许基于在线PaO2测量值执行自动复张操作（开放肺概念）。我们发现，EIT是一个有用的工具，滴定适当的PEEP水平后，充分招募肺。此外，EIT似乎能够确定招聘的状态时，结合其他生理参数。这些结果表明，EIT可能在保护性通气策略的个性化中发挥重要作用。
Dynamic thoracic EIT is capable of detecting changes of the ventilation distribution in the lung. Nevertheless, it has yet to become an established clinical tool. Therefore, it is necessary to consider application scenarios wherein fast and distinct changes of the tissue conductivities are to be found and also have a clear diagnostic significance. One such a scenario is the artificial ventilation of patients suffering from the acute respiratory distress syndrome (ARDS). New protective ventilation strategies involving recruitment manoeuvres are associated with noticeable shifts of body fluids and regional ventilation, which can quite easily be detected by EIT. The bedside assessment of these recruitment manoeuvres will help the attending physician to optimize treatment. Hence, we performed an animal study of lavage-induced lung failure and investigated if EIT is capable of qualitatively as well as quantitatively monitoring lung recruitment during a stepwise PEEP trial. Additionally, we integrated EIT into a fuzzy controller-based ventilation system which allows one to perform automated recruitment manoeuvres (open lung concept) based on online PaO2 measurements. We found that EIT is a useful tool to titrate the proper PEEP level after fully recruiting the lung. Furthermore, EIT seems to be able to determine the status of recruitment when combining it with other physiological parameters. These results suggest that EITmay play an important role in the individualization of protective ventilation strategies.