Document Detail

Assessment of regional lung recruitment and derecruitment during a PEEP trial based on electrical impedance tomography.
MedLine Citation:
PMID:  17653529     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To investigate whether electrical impedance tomography (EIT) is capable of monitoring regional lung recruitment and lung collapse during a positive end-expiratory pressure (PEEP) trial. DESIGN: Experimental animal study of acute lung injury. SUBJECT: Six pigs with saline-lavage-induced acute lung injury. INTERVENTIONS: An incremental and decremental PEEP trial at ten pressure levels was performed. Ventilatory, gas exchange, and hemodynamic parameters were automatically recorded. EIT and computed tomography (CT) scans of the same slice were simultaneously taken at each PEEP level. MEASUREMENTS AND RESULTS: A significant correlation between EIT and CT analyses of end-expiratory gas volumes (r=0.98 up to 0.99) and tidal volumes (r=0.55 up to r=0.88) could be demonstrated. Changes in global and regional tidal volumes and arterial oxygenation (PaO2/FiO2) demonstrated recruitment/derecruitment during the trial, but at different onsets. During the decremental trial, derecruitment first occurred in dependent lung areas. This was indicated by lowered regional tidal volumes measured in this area and by a decrease of PaO2/FiO2. At the same time, the global tidal volume still continued to increase, because the increase of ventilation of the non-dependent areas was higher than the loss in the dependent areas. This indicates that opposing regional changes might cancel each other out when combined in a global parameter. CONCLUSIONS: EIT is suitable for monitoring the dynamic effects of PEEP variations on the regional change of tidal volume. It is superior to global ventilation parameters in assessing the beginning of alveolar recruitment and lung collapse.
Torsten Meier; Henning Luepschen; Jan Karsten; Thorsten Leibecke; Martin Grossherr; Hartmut Gehring; Steffen Leonhardt
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Publication Detail:
Type:  Journal Article     Date:  2007-07-25
Journal Detail:
Title:  Intensive care medicine     Volume:  34     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-15     Completed Date:  2008-09-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  543-50     Citation Subset:  IM    
Department of Anesthesiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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MeSH Terms
Bronchoalveolar Lavage
Disease Models, Animal
Electric Impedance
Lung / physiopathology*
Lung Compliance
Monitoring, Physiologic / methods
Positive-Pressure Respiration / methods*
Pulmonary Gas Exchange
Respiratory Distress Syndrome, Adult / blood,  physiopathology*,  therapy*
Tomography / methods
Comment In:
Intensive Care Med. 2008 Mar;34(3):400-1; author reply 583   [PMID:  18214441 ]
Intensive Care Med. 2008 Mar;34(3):584; author reply 585-6   [PMID:  18214431 ]

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