A Modified Method to Assess Tidal Recruitment by Electrical Impedance Tomography
Abstract
:1. Introduction
2. Animals and Methods
2.1. Animals and Ethics
2.2. Study Protocol
Anesthesia, Ventilatory Settings, and Induction of Lung Injury
2.3. Measurements and Data Analysis
2.3.1. Computed Tomography
2.3.2. Electrical Impedance Tomography
2.3.3. Quantification of Heterogeneity in Ventilatory Time Courses
2.3.4. Selection of Definite RVDI Thresholds to Predict Tidal Recruitment
2.4. Statistical Analysis
3. Results
3.1. Lung Injury and Cardiopulmonary Effects of Different PEEP Levels
3.2 Temporal Heterogeneity Measured by EIT
3.3. End-Inspiratory Pressures Resulting from Different Slow Inflation VT Maneuvers
3.4. Tidal Recruitment at Different PEEP Levels
3.5. Correlation of RVDI and Tidal Recruitment Obtained from Different Slow Inflation VT Maneuvers
3.6. Prediction of Tidal Recruitment thresholds from RVDI Values
4. Discussion
- RVDI can be derived from slow inflation maneuvers using a low VT of 6 to 9 mL/kg BW, to quantify temporal heterogeneity of regional ventilatory time courses.
- Absolute RVDI values are not comparable when derived from slow inflation maneuvers using different VTs.
- RVDI values from slow inflation maneuvers using low VTs of 6 to 9 mL/kg BW correlate with tidal recruitment.
4.1. Effects of Slow Inflation VT on RVDI-Values
4.2. Assessment of Tidal Recruitment Using RVDI Measurements
4.3. PEEP Titration Using EIT
4.3.1. EIT-Based Approaches to Individually Titrate PEEP
4.3.2. Regional Ventilation Delay Inhomogeneity to Individually Titrate PEEP
4.4. Clinical Applicability of RVDI Measurements
4.5. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
References
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Comparison of RVDI Values | Slow Inflation Tidal Volume of 12 mL/kg BW vs. | ||
---|---|---|---|
9 mL/kg BW | 7.5 mL/kg BW | 6 mL/kg BW | |
inter-individual comparison, all animals (n = 7) | |||
linear correlation, R2, p < 0.001 | 0.93 | 0.84 | 0.76 |
Bland Altman analysis | |||
Bias ± SD | −1.5 ± 1.2 | −2.4 ± 1.9 | −3.3 ± 2.3 |
95% limits of agreement | −4.0 to 1.0 | −6.1 to 1.2 | −7.8 to 1.2 |
intra-individual comparison | |||
linear correlation, R2, p < 0.001, respectively | |||
pig 1 | 0.91 | 0.79 | 0.69 |
pig 2 | 0.9 | 0.8 | 0.73 |
pig 3 | 0.97 | 0.94 | 0.86 |
pig 4 | 0.99 | 0.99 | 0.96 |
pig 5 | 0.99 | 0.99 | 0.97 |
pig 6 | 0.85 | 0.62 | 0.37 |
pig 7 | 0.98 | 0.94 | 0.86 |
Comparison of Tidal Recruitment Versus | RVDI Values Calculated from a Slow Inflation Tidal Volume of | |||
---|---|---|---|---|
12 mL/kg BW | 9 mL/kg BW | 7.5 mL/kg BW | 6 mL/kg BW | |
inter-individual comparison, all animals (n = 7) | ||||
linear correlation, R2, p < 0.001 | 0.83 | 0.83 | 0.76 | 0.71 |
intra-individual comparison | ||||
linear correlation, R2, p < 0.001, respectively | ||||
pig 1 | 0.97 | 0.91 | 0.81 | 0.72 |
pig 2 | 0.91 | 0.95 | 0.95 | 0.94 |
pig 3 | 0.96 | 0.94 | 0.94 | 0.86 |
pig 4 | 0.95 | 0.95 | 0.91 | 0.82 |
pig 5 | 0.83 | 0.77 | 0.75 | 0.74 |
pig 6 | 0.87 | 0.62 | 0.33 | 0.12 |
pig 7 | 0.9 | 0.93 | 0.98 | 0.78 |
ROC Curve Analysis | RVDI Calculated from a Slow Inflation Tidal Volume of | |||
---|---|---|---|---|
12 mL/kg BW | 9 mL/kg BW | 7.5 mL/kg BW | 6 mL/kg BW | |
tidal recruitment above 2% of lung volume | ||||
AUC | 0.869 | 0.847 | 0.855 | 0.828 |
SE | 0.0597 | 0.0688 | 0.0680 | 0.0708 |
95% CI | 0.722 to 0.955 | 0.695 to 0.942 | 0.706 to 0.947 | 0.673 to 0.929 |
tidal recruitment above 4% of lung volume | ||||
AUC | 0.908 | 0.891 | 0.897 | 0.887 |
SE | 0.0533 | 0.0537 | 0.0521 | 0.0583 |
95% CI | 0.771 to 0.977 | 0.749 to 0.968 | 0.758 to 0.971 | 0.744 to 0.966 |
RVDI-threshold-based prediction of an increase in tidal recruitment above 2 (% lung) during decremental PEEP titration | ||||
RVDI criterion (% inflation time) | >5.36 | >4.39 | >4.15 | >3.34 |
Sensitivity (%) | 90 | 90 | 90 | 90 |
Specificity (%) | 40 | 50 | 60 | 40 |
RVDI-threshold-based prediction of an increase in tidal recruitment above 4 (% lung) during decremental PEEP titration | ||||
RVDI criterion (% inflation time) | >6.77 | >5.66 | >4.88 | >4.66 |
Sensitivity (%) | 90 | 90 | 90 | 90 |
Specificity (%) | 63 | 68 | 74 | 74 |
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Muders, T.; Hentze, B.; Simon, P.; Girrbach, F.; Doebler, M.R.G.; Leonhardt, S.; Wrigge, H.; Putensen, C. A Modified Method to Assess Tidal Recruitment by Electrical Impedance Tomography. J. Clin. Med. 2019, 8, 1161. https://doi.org/10.3390/jcm8081161
Muders T, Hentze B, Simon P, Girrbach F, Doebler MRG, Leonhardt S, Wrigge H, Putensen C. A Modified Method to Assess Tidal Recruitment by Electrical Impedance Tomography. Journal of Clinical Medicine. 2019; 8(8):1161. https://doi.org/10.3390/jcm8081161
Chicago/Turabian StyleMuders, Thomas, Benjamin Hentze, Philipp Simon, Felix Girrbach, Michael R.G. Doebler, Steffen Leonhardt, Hermann Wrigge, and Christian Putensen. 2019. "A Modified Method to Assess Tidal Recruitment by Electrical Impedance Tomography" Journal of Clinical Medicine 8, no. 8: 1161. https://doi.org/10.3390/jcm8081161