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Effect of positive end-expiratory-pressure on regional ventilation in patients with acute lung injury evaluated by electrical impedance tomography

Published online by Cambridge University Press:  13 October 2005

J. Hinz ,
O. Moerer ,
P. Neumann ,
T. Dudykevych ,
G. Hellige  and
M. Quintel
J. Hinz
Affiliation:
University Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany
O. Moerer
Affiliation:
University Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany
P. Neumann
Affiliation:
University Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany
T. Dudykevych
Affiliation:
University Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany
G. Hellige
Affiliation:
University Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany
M. Quintel
Affiliation:
University Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Germany
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Extract

Summary

Background and objective: For the treatment of patients with adult respiratory distress syndrome and acute lung injury bedside measurements of regional lung ventilation should be considered for optimizing ventilatory settings. The aim was to investigate the effect of positive end-expiratory pressure (PEEP) on regional ventilation in mechanically ventilated patients at the bedside by electrical impedance tomography. Methods: Eight mechanically ventilated patients were included in the study. PEEP levels were increased from 0 to 5, 10, 15 mbar and back to 0 mbar. Regional ventilation in 912 regions of the thorax was investigated at each PEEP by electrical impedance tomography. The obtained regions were divided in four groups: none (none and poorly ventilated regions including chest wall and mediastinum), bad, moderate and well-ventilated regions. Results: Increasing the PEEP stepwise from 0 to 15 mbar decreased the non-ventilated regions (none: 540 regions at PEEP 0 and 406 regions at PEEP 15). In contrast, the other regions increased (bad: 316 regions at PEEP 0 and 380 regions at PEEP 15; moderate: 40 regions at PEEP 0 and 100 regions at PEEP 15; well: 0 region at PEEP 0 and 34 regions at PEEP 15 (median values)) indicating an improvement of regional ventilation. Conclusions: Increasing PEEP in mechanically ventilated patients reduces none ventilated regions (atelectasis). Furthermore, it leads to a shift from none and bad ventilated regions to moderately and well-ventilated regions. Electrical impedance tomography is a bedside technique and might be an alternative to computed tomography scan to assess aerated lung regions.

Keywords

THORACIC ELECTRICAL IMPEDANCE TOMOGRAPHY, regional ventilation, positive end-expiratory pressure
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 11 , November 2005 , pp. 817 - 825
Copyright
© 2005 European Society of Anaesthesiology

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