Optimizing PEEP by Electrical Impedance Tomography in a Porcine Animal Model of ARDS.
BACKGROUND: Mechanical ventilation is necessary in diverse clinical circumstances. Especially in the context of ARDS, so-called protective ventilation strategies must be followed. It is already known that PEEP might enhance oxygenation in ARDS. However, determining the optimal PEEP settings in clini...
| Publicado en: | Respiratory Care Vol. 62; no. 3; pp. 340 - 350 |
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| Autores principales: | , , , , , , , |
| Formato: | Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Mar2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121560501&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 121560501 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Mar2017 vid: 62 iid: 3 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 121560501 10.4187/respcare.05060 121560501 ppf: 340 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Optimizing PEEP by Electrical Impedance Tomography in a Porcine Animal Model of ARDS. aug: au: Hochhausen, Nadine Biener, Ingeborg Rossaint, Rolf Follmann, Andreas Bleilevens, Christian Braunschweig, Till Leonhardt, Steffen Czaplik, Michael affil: Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany sug: subj: Electric Impedance Tomography, X-Ray Computed Positive End-Expiratory Pressure Treatment Outcomes Respiratory Distress Syndrome, Acute Therapy Animal Studies Hemodynamics Lung Positive Pressure Ventilation Pulmonary Surfactants Respiration, Artificial Swine Ventilator-Induced Lung Injury Tidal Volume Mann-Whitney U Test Data Analysis Software P-Value ab: BACKGROUND: Mechanical ventilation is necessary in diverse clinical circumstances. Especially in the context of ARDS, so-called protective ventilation strategies must be followed. It is already known that PEEP might enhance oxygenation in ARDS. However, determining the optimal PEEP settings in clinical routines is challenging. Electrical impedance tomography (EIT) is a promising technique with which to adjust ventilator settings. We investigated whether the combination of different EIT parameters, namely the global inhomogeneity and hyperdistension indices, may lead to a feasible and safe PEEP setting. METHODS: ARDS was induced by a double-hit approach in 18 pigs weighing, on average, 34.8 ± 3.97 kg. First, a surfactant washout was conducted; second, the tidal volume was increased to 20 mL/kg body weight, triggering a ventilator-induced lung injury. Subsequently, pigs were randomized to either the EIT or control groups, followed by an observation time of 24 h. In the control group, PEEP was set according to the ARDS network table. In the EIT group, a PEEP trial was conducted to determine an appropriate PEEP. At defined time points, hemodynamic measures, ventilation parameters, and EIT recordings, as well as blood samples, were taken. After euthanization, lungs were removed for subsequent histopathological and cytological examination. RESULTS: The combination of PEEP and F... differed between groups, although respiratory compliance, gas exchange, and histopathological examinations, as well as hemodynamics, did not show any statistical differences between the EIT and control groups. However, in the control group, the PEEP/F... settings followed the given coupling; in the EIT group, divergent individual combinations of PEEP and F... ranges occurred. CONCLUSIONS: PEEP setting by EIT facilitates a more individual ventilation therapy. However, in our relatively short ARDS observation period of 24 h, no significant differences appeared in common clinical parameters compared with a control group. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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