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Open AccessArticle

A Modified Method to Assess Tidal Recruitment by Electrical Impedance Tomography

1
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn 53127, Germany
2
Chair for Medical Information Technology, RWTH Aachen University, Aachen 52074, Germany
3
Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig 04103, Germany
4
Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Halle 06112, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(8), 1161; https://doi.org/10.3390/jcm8081161
Received: 30 June 2019 / Revised: 29 July 2019 / Accepted: 1 August 2019 / Published: 3 August 2019
Avoiding tidal recruitment and collapse during mechanical ventilation should reduce the risk of lung injury. Electrical impedance tomography (EIT) enables detection of tidal recruitment by measuring regional ventilation delay inhomogeneity (RVDI) during a slow inflation breath with a tidal volume (VT) of 12 mL/kg body weight (BW). Clinical applicability might be limited by such high VTs resulting in high end-inspiratory pressures (PEI) during positive end-expiratory pressure (PEEP) titration. We hypothesized that RVDI can be obtained with acceptable accuracy from reduced slow inflation VTs. In seven ventilated pigs with experimental lung injury, tidal recruitment was quantified by computed tomography at PEEP levels changed stepwise between 0 and 25 cmH2O. RVDI was measured by EIT during slow inflation VTs of 12, 9, 7.5, and 6 mL/kg BW. Linear correlation of tidal recruitment and RVDI was excellent for VTs of 12 (R2 = 0.83, p < 0.001) and 9 mL/kg BW (R2 = 0.83, p < 0.001) but decreased for VTs of 7.5 (R2 = 0.76, p < 0.001) and 6 mL/kg BW (R2 = 0.71, p < 0.001). With any reduction in slow inflation VT, PEI decreased at all PEEP levels. Receiver-Operator-Characteristic curve analyses revealed that RVDI-thresholds to predict distinct amounts of tidal recruitment differ when obtained from different slow inflation VTs. In conclusion, tidal recruitment can sufficiently be monitored by EIT-based RVDI-calculation with a slow inflation of 9 mL/kg BW. View Full-Text
Keywords: acute respiratory distress syndrome; positive end-expiratory pressure; electrical impedance tomography; computed tomography; monitoring; functional imaging acute respiratory distress syndrome; positive end-expiratory pressure; electrical impedance tomography; computed tomography; monitoring; functional imaging
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Muders, T.; Hentze, B.; Simon, P.; Girrbach, F.; Doebler, M.R.; Leonhardt, S.; Wrigge, H.; Putensen, C. A Modified Method to Assess Tidal Recruitment by Electrical Impedance Tomography. J. Clin. Med. 2019, 8, 1161.

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