Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment

Savino Spadaro, Tommaso Mauri, Stephan H. Böhm, Gaetano Scaramuzzo, Cecilia Turrini, Andreas D. Waldmann, Riccardo Ragazzi, Antonio Pesenti, Carlo Alberto Volta

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Assessing alveolar recruitment at different positive end-expiratory pressure (PEEP) levels is a major clinical and research interest because protective ventilation implies opening the lung without inducing overdistention. The pressure-volume (P-V) curve is a validated method of assessing recruitment but reflects global characteristics, and changes at the regional level may remain undetected. The aim of the present study was to compare, in intubated patients with acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS), lung recruitment measured by P-V curve analysis, with dynamic changes in poorly ventilated units of the dorsal lung (dependent silent spaces [DSSs]) assessed by electrical impedance tomography (EIT). We hypothesized that DSSs might represent a dynamic bedside measure of recruitment. Methods: We carried out a prospective interventional study of 14 patients with AHRF and ARDS admitted to the intensive care unit undergoing mechanical ventilation. Each patient underwent an incremental/decremental PEEP trial that included five consecutive phases: PEEP 5 and 10 cmH2O, recruitment maneuver+PEEP 15 cmH2O, then PEEP 10 and 5 cmH2O again. We measured, at the end of each phase, recruitment from previous PEEP using the P-V curve method, and changes in DSS were continuously monitored by EIT. Results: PEEP changes induced alveolar recruitment as assessed by the P-V curve method and changes in the amount of DSS (p<0.001). Recruited volume measured by the P-V curves significantly correlated with the change in DSS (r s=0.734, p<0.001). Regional compliance of the dependent lung increased significantly with rising PEEP (median PEEP 5 cmH2O=11.9 [IQR 10.4-16.7] ml/cmH2O, PEEP 15 cmH2O=19.1 [14.2-21.3] ml/cmH2O; p<0.001), whereas regional compliance of the nondependent lung decreased from PEEP 5 cmH2O to PEEP 15 cmH2O (PEEP 5 cmH2O=25.3 [21.3-30.4] ml/cmH2O, PEEP 15 cmH2O=20.0 [16.6-22.8] ml/cmH2O; p <0.001). By increasing the PEEP level, the center of ventilation moved toward the dependent lung, returning to the nondependent lung during the decremental PEEP steps. Conclusions: The variation of DSSs dynamically measured by EIT correlates well with lung recruitment measured using the P-V curve technique. EIT might provide useful information to titrate personalized PEEP.

Original languageEnglish
Article number26
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - Jan 31 2018

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Positive-Pressure Respiration
Electric Impedance
Tomography
Lung
Pressure
Lung Compliance
Adult Respiratory Distress Syndrome
Respiratory Insufficiency
Ventilation

Keywords

  • Acute respiratory distress syndrome
  • Acute respiratory failure
  • Electrical impedance tomography
  • Personalized medicine
  • Positive end-expiratory pressure
  • Pressure-volume curve

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment. / Spadaro, Savino; Mauri, Tommaso; Böhm, Stephan H.; Scaramuzzo, Gaetano; Turrini, Cecilia; Waldmann, Andreas D.; Ragazzi, Riccardo; Pesenti, Antonio; Volta, Carlo Alberto.

In: Critical Care, Vol. 22, No. 1, 26, 31.01.2018.

Research output: Contribution to journalArticle

Spadaro, Savino ; Mauri, Tommaso ; Böhm, Stephan H. ; Scaramuzzo, Gaetano ; Turrini, Cecilia ; Waldmann, Andreas D. ; Ragazzi, Riccardo ; Pesenti, Antonio ; Volta, Carlo Alberto. / Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment. In: Critical Care. 2018 ; Vol. 22, No. 1.
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abstract = "Background: Assessing alveolar recruitment at different positive end-expiratory pressure (PEEP) levels is a major clinical and research interest because protective ventilation implies opening the lung without inducing overdistention. The pressure-volume (P-V) curve is a validated method of assessing recruitment but reflects global characteristics, and changes at the regional level may remain undetected. The aim of the present study was to compare, in intubated patients with acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS), lung recruitment measured by P-V curve analysis, with dynamic changes in poorly ventilated units of the dorsal lung (dependent silent spaces [DSSs]) assessed by electrical impedance tomography (EIT). We hypothesized that DSSs might represent a dynamic bedside measure of recruitment. Methods: We carried out a prospective interventional study of 14 patients with AHRF and ARDS admitted to the intensive care unit undergoing mechanical ventilation. Each patient underwent an incremental/decremental PEEP trial that included five consecutive phases: PEEP 5 and 10 cmH2O, recruitment maneuver+PEEP 15 cmH2O, then PEEP 10 and 5 cmH2O again. We measured, at the end of each phase, recruitment from previous PEEP using the P-V curve method, and changes in DSS were continuously monitored by EIT. Results: PEEP changes induced alveolar recruitment as assessed by the P-V curve method and changes in the amount of DSS (p<0.001). Recruited volume measured by the P-V curves significantly correlated with the change in DSS (r s=0.734, p<0.001). Regional compliance of the dependent lung increased significantly with rising PEEP (median PEEP 5 cmH2O=11.9 [IQR 10.4-16.7] ml/cmH2O, PEEP 15 cmH2O=19.1 [14.2-21.3] ml/cmH2O; p<0.001), whereas regional compliance of the nondependent lung decreased from PEEP 5 cmH2O to PEEP 15 cmH2O (PEEP 5 cmH2O=25.3 [21.3-30.4] ml/cmH2O, PEEP 15 cmH2O=20.0 [16.6-22.8] ml/cmH2O; p <0.001). By increasing the PEEP level, the center of ventilation moved toward the dependent lung, returning to the nondependent lung during the decremental PEEP steps. Conclusions: The variation of DSSs dynamically measured by EIT correlates well with lung recruitment measured using the P-V curve technique. EIT might provide useful information to titrate personalized PEEP.",
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author = "Savino Spadaro and Tommaso Mauri and B{\"o}hm, {Stephan H.} and Gaetano Scaramuzzo and Cecilia Turrini and Waldmann, {Andreas D.} and Riccardo Ragazzi and Antonio Pesenti and Volta, {Carlo Alberto}",
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T1 - Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment

AU - Spadaro, Savino

AU - Mauri, Tommaso

AU - Böhm, Stephan H.

AU - Scaramuzzo, Gaetano

AU - Turrini, Cecilia

AU - Waldmann, Andreas D.

AU - Ragazzi, Riccardo

AU - Pesenti, Antonio

AU - Volta, Carlo Alberto

PY - 2018/1/31

Y1 - 2018/1/31

N2 - Background: Assessing alveolar recruitment at different positive end-expiratory pressure (PEEP) levels is a major clinical and research interest because protective ventilation implies opening the lung without inducing overdistention. The pressure-volume (P-V) curve is a validated method of assessing recruitment but reflects global characteristics, and changes at the regional level may remain undetected. The aim of the present study was to compare, in intubated patients with acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS), lung recruitment measured by P-V curve analysis, with dynamic changes in poorly ventilated units of the dorsal lung (dependent silent spaces [DSSs]) assessed by electrical impedance tomography (EIT). We hypothesized that DSSs might represent a dynamic bedside measure of recruitment. Methods: We carried out a prospective interventional study of 14 patients with AHRF and ARDS admitted to the intensive care unit undergoing mechanical ventilation. Each patient underwent an incremental/decremental PEEP trial that included five consecutive phases: PEEP 5 and 10 cmH2O, recruitment maneuver+PEEP 15 cmH2O, then PEEP 10 and 5 cmH2O again. We measured, at the end of each phase, recruitment from previous PEEP using the P-V curve method, and changes in DSS were continuously monitored by EIT. Results: PEEP changes induced alveolar recruitment as assessed by the P-V curve method and changes in the amount of DSS (p<0.001). Recruited volume measured by the P-V curves significantly correlated with the change in DSS (r s=0.734, p<0.001). Regional compliance of the dependent lung increased significantly with rising PEEP (median PEEP 5 cmH2O=11.9 [IQR 10.4-16.7] ml/cmH2O, PEEP 15 cmH2O=19.1 [14.2-21.3] ml/cmH2O; p<0.001), whereas regional compliance of the nondependent lung decreased from PEEP 5 cmH2O to PEEP 15 cmH2O (PEEP 5 cmH2O=25.3 [21.3-30.4] ml/cmH2O, PEEP 15 cmH2O=20.0 [16.6-22.8] ml/cmH2O; p <0.001). By increasing the PEEP level, the center of ventilation moved toward the dependent lung, returning to the nondependent lung during the decremental PEEP steps. Conclusions: The variation of DSSs dynamically measured by EIT correlates well with lung recruitment measured using the P-V curve technique. EIT might provide useful information to titrate personalized PEEP.

AB - Background: Assessing alveolar recruitment at different positive end-expiratory pressure (PEEP) levels is a major clinical and research interest because protective ventilation implies opening the lung without inducing overdistention. The pressure-volume (P-V) curve is a validated method of assessing recruitment but reflects global characteristics, and changes at the regional level may remain undetected. The aim of the present study was to compare, in intubated patients with acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS), lung recruitment measured by P-V curve analysis, with dynamic changes in poorly ventilated units of the dorsal lung (dependent silent spaces [DSSs]) assessed by electrical impedance tomography (EIT). We hypothesized that DSSs might represent a dynamic bedside measure of recruitment. Methods: We carried out a prospective interventional study of 14 patients with AHRF and ARDS admitted to the intensive care unit undergoing mechanical ventilation. Each patient underwent an incremental/decremental PEEP trial that included five consecutive phases: PEEP 5 and 10 cmH2O, recruitment maneuver+PEEP 15 cmH2O, then PEEP 10 and 5 cmH2O again. We measured, at the end of each phase, recruitment from previous PEEP using the P-V curve method, and changes in DSS were continuously monitored by EIT. Results: PEEP changes induced alveolar recruitment as assessed by the P-V curve method and changes in the amount of DSS (p<0.001). Recruited volume measured by the P-V curves significantly correlated with the change in DSS (r s=0.734, p<0.001). Regional compliance of the dependent lung increased significantly with rising PEEP (median PEEP 5 cmH2O=11.9 [IQR 10.4-16.7] ml/cmH2O, PEEP 15 cmH2O=19.1 [14.2-21.3] ml/cmH2O; p<0.001), whereas regional compliance of the nondependent lung decreased from PEEP 5 cmH2O to PEEP 15 cmH2O (PEEP 5 cmH2O=25.3 [21.3-30.4] ml/cmH2O, PEEP 15 cmH2O=20.0 [16.6-22.8] ml/cmH2O; p <0.001). By increasing the PEEP level, the center of ventilation moved toward the dependent lung, returning to the nondependent lung during the decremental PEEP steps. Conclusions: The variation of DSSs dynamically measured by EIT correlates well with lung recruitment measured using the P-V curve technique. EIT might provide useful information to titrate personalized PEEP.

KW - Acute respiratory distress syndrome

KW - Acute respiratory failure

KW - Electrical impedance tomography

KW - Personalized medicine

KW - Positive end-expiratory pressure

KW - Pressure-volume curve

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