Document Detail


Tidal recruitment assessed by electrical impedance tomography and computed tomography in a porcine model of lung injury.
MedLine Citation:
PMID:  22202705     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES:: To determine the validity of electrical impedance tomography to detect and quantify the amount of tidal recruitment caused by different positive end-expiratory pressure levels in a porcine acute lung injury model. DESIGN:: Randomized, controlled, prospective experimental study. SETTING:: Academic research laboratory. SUBJECTS:: Twelve anesthetized and mechanically ventilated pigs. INTERVENTIONS:: Acute lung injury was induced by central venous oleic acid injection and abdominal hypertension in seven animals. Five healthy pigs served as control group. Animals were ventilated with positive end-expiratory pressure of 0, 5, 10, 15, 20, and 25 cm H2O, respectively, in a randomized order. MEASUREMENTS AND MAIN RESULTS:: At any positive end-expiratory pressure level, electrical impedance tomography was obtained during a slow inflation of 12 mL/kg of body weight. Regional-ventilation-delay indices quantifying the time until a lung region reaches a certain amount of impedance change were calculated for lung quadrants and for every single electrical impedance tomography pixel, respectively. Pixel-wise calculated regional-ventilation-delay indices were plotted in a color-coded regional-ventilation-delay map. Regional-ventilation-delay inhomogeneity that quantifies heterogeneity of ventilation time courses was evaluated by calculating the scatter of all pixel-wise calculated regional-ventilation-delay indices. End-expiratory and end-inspiratory computed tomography scans were performed at each positive end-expiratory pressure level to quantify tidal recruitment of the lung. Tidal recruitment showed a moderate inter-individual (r = .54; p < .05) and intra-individual linear correlation (r = .46 up to r = .73 and p < .05, respectively) with regional-ventilation-delay obtained from lung quadrants. Regional-ventilation-delay inhomogeneity was excellently correlated with tidal recruitment intra- (r = .90 up to r = .99 and p < .05, respectively) and inter-individually (r = .90; p < .001). CONCLUSIONS:: Regional-ventilation-delay can be noninvasively measured by electrical impedance tomography during a slow inflation of 12 mL/kg of body weight and visualized using ventilation delay maps. Our experimental data suggest that the impedance tomography-based analysis of regional-ventilation-delay inhomogeneity provides a good estimate of the amount of tidal recruitment and may be useful to individualize ventilatory settings.
Authors:
Thomas Muders; Henning Luepschen; Jörg Zinserling; Susanne Greschus; Rolf Fimmers; Ulf Guenther; Miriam Buchwald; Daniel Grigutsch; Steffen Leonhardt; Christian Putensen; Hermann Wrigge
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-24
Journal Detail:
Title:  Critical care medicine     Volume:  -     ISSN:  1530-0293     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Department of Anesthesiology and Intensive Care Medicine (TM, HL, JZ, UG, MB, DG, CP, HW), University of Bonn, Bonn, Germany; Philips Chair for Medical Information Technology (HL, SL), Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany; Department of Radiology (SG), University of Bonn, Bonn, Germany; Institute for Medical Biometry, Informatics, and Epidemiology (RF), University of Bonn, Germany; Department of Anesthesiology and Intensive Care Medicine (HW), University of Leipzig, Germany.
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