Application of regional mechanical power monitored by electrical impedance tomography during positive end-expiratory pressure titration in acute respiratory distress syndrome patients

doi:10.3877/cma.j.issn.2096-1537.2019.02.007

Abstract

Abstract:

Objective

To investigate regional gas distribution and regional mechanical power during positive end-expiratory pressure (PEEP) titration in acute respiratory distress syndrome (ARDS) patients using electrical impedance tomography (EIT).

Methods

Ten ARDS patients admitted to Peking Union Medical College Hospital from November 2018 to February 2019 and receiving invasive mechanical ventilation were studied. A descending PEEP trial (15-0 cmH₂O, 1 cmH₂O=0.098 kPa) in 3 cmH₂O steps was monitored by EIT, with lung images divided into four ventral-to-dorsal horizontal regions of interest (ROIs) 1 and 2 represent non-dependent areas, while ROIs 3 and 4 represent dependent areas). Gas distributions in the four regions were recorded, with which regional mechanical powers in each region were calculated.

Results

With PEEP decreasing from 15 cmH₂O to 0 cmH₂O, tidal volumes significantly decreased in dependent areas (F=5.611, P<0.001), but significantly increased in non-dependent areas (F=5.587, P<0.001). Ventilation shifted from dorsal regions to ventral regions during the descending PEEP trial. With PEEP decreasing from 15 cmH₂O to 0 cmH₂O, global mechanical power decreased significantly (F=19.601, P<0.001); mechanical power decreased significantly in ROIs 2-4 (F=4.130, P=0.003; F=30.690, P<0.001; F=16.744, P<0.005) but did not change significantly in ROI 1 (F=0.460, P=0.804).

Conclusions

Regional mechanical power can be monitored by EIT. Global mechanical power decreases during the descending PEEP trial, while regional mechanical power may increase in some cases, which may help in the selection of PEEP.

Key words: Electrical impedance tomography, Mechanical power, Positive end-expiratory pressure, Respiratory distress syndrome, adult

Yi Chi, Huaiwu He, Siyi Yuan, Zhanqi Zhao, Yun Long. Application of regional mechanical power monitored by electrical impedance tomography during positive end-expiratory pressure titration in acute respiratory distress syndrome patients[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(02): 115-119.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2019.02.007

https://icu.cma-cmc.com.cn/EN/Y2019/V05/I02/115

Figures/Tables 3

References 15

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PEEP	例数	非依赖区	ROI 1区	ROI 2区	依赖区	ROI 3区	ROI 4区
15 cmH₂O	10	53.2±7.1	8.4±2.7	44.8±6.0	47.0±6.9	40.1±5.8	6.9±2.3
12 cmH₂O	10	56.6±7.6	9.1±3.1	47.5±6.3	43.1±7.5	37.6±7.0	5.5±1.9
9 cmH₂O	10	60.7±7.9	10.4±3.9	50.3±5.9	39.3±7.8	34.5±7.9	4.8±2.1
6 cmH₂O	10	64.0±8.8	11.2±4.3	52.8±6.5	36.3±8.9	31.9±9.3	4.4±2.2
3 cmH₂O	10	67.9±9.2	12.0±4.5	55.9±6.9	32.1±9.4	28.1±9.6	4.0±2.4
0 cmH₂O	10	70.0±10.8	12.6±5.0	57.3±8.3	30.1±10.7	26.5±10.6	3.6±2.5
F值	?	5.587	1.678	5.228	5.611	3.884	2.806
P值	?	<0.001	0.156	<0.001	<0.001	0.004	0.025

PEEP	例数	非依赖区	ROI 1区	ROI 2区	依赖区	ROI 3区	ROI 4区
15 cmH₂O	10	53.2±7.1	8.4±2.7	44.8±6.0	47.0±6.9	40.1±5.8	6.9±2.3
12 cmH₂O	10	56.6±7.6	9.1±3.1	47.5±6.3	43.1±7.5	37.6±7.0	5.5±1.9
9 cmH₂O	10	60.7±7.9	10.4±3.9	50.3±5.9	39.3±7.8	34.5±7.9	4.8±2.1
6 cmH₂O	10	64.0±8.8	11.2±4.3	52.8±6.5	36.3±8.9	31.9±9.3	4.4±2.2
3 cmH₂O	10	67.9±9.2	12.0±4.5	55.9±6.9	32.1±9.4	28.1±9.6	4.0±2.4
0 cmH₂O	10	70.0±10.8	12.6±5.0	57.3±8.3	30.1±10.7	26.5±10.6	3.6±2.5
F值	?	5.587	1.678	5.228	5.611	3.884	2.806
P值	?	<0.001	0.156	<0.001	<0.001	0.004	0.025

PEEP	例数	总机械能	非依赖区	ROI 1区	ROI 2区	依赖区	ROI 3区	ROI 4区
15 cmH₂O	10	16.2±2.3	8.7±2.0	1.4±0.6	7.3±1.5	7.5±1.1	6.4±0.9	1.1±0.4
12 cmH₂O	10	13.6±2.1	7.8±1.8	1.3±0.5	6.5±1.4	5.8±1.0	5.1±1.0	0.8±0.2
9 cmH₂O	10	12.0±2.0	7.3±1.8	1.3±0.6	6.1±1.4	4.6±0.9	4.1±0.9	0.6±0.3
6 cmH₂O	10	10.3±2.1	6.7±1.8	1.2±0.6	5.5±1.4	3.7±0.9	3.3±1.1	0.4±0.2
3 cmH₂O	10	9.1±2.1	6.3±1.9	1.1±0.5	5.2±1.5	2.9±0.8	2.5±0.9	0.4±0.2
0 cmH₂O	10	8.0±2.4	5.7±2.1	1.1±0.6	4.7±1.7	2.3±0.8	2.1±0.8	0.3±0.1
F值	?	19.601	3.217	0.460	4.130	43.837	30.690	16.744
P值	?	<0.001	0.013	0.804	0.003	<0.001	<0.001	<0.001

PEEP	例数	总机械能	非依赖区	ROI 1区	ROI 2区	依赖区	ROI 3区	ROI 4区
15 cmH₂O	10	16.2±2.3	8.7±2.0	1.4±0.6	7.3±1.5	7.5±1.1	6.4±0.9	1.1±0.4
12 cmH₂O	10	13.6±2.1	7.8±1.8	1.3±0.5	6.5±1.4	5.8±1.0	5.1±1.0	0.8±0.2
9 cmH₂O	10	12.0±2.0	7.3±1.8	1.3±0.6	6.1±1.4	4.6±0.9	4.1±0.9	0.6±0.3
6 cmH₂O	10	10.3±2.1	6.7±1.8	1.2±0.6	5.5±1.4	3.7±0.9	3.3±1.1	0.4±0.2
3 cmH₂O	10	9.1±2.1	6.3±1.9	1.1±0.5	5.2±1.5	2.9±0.8	2.5±0.9	0.4±0.2
0 cmH₂O	10	8.0±2.4	5.7±2.1	1.1±0.6	4.7±1.7	2.3±0.8	2.1±0.8	0.3±0.1
F值	?	19.601	3.217	0.460	4.130	43.837	30.690	16.744
P值	?	<0.001	0.013	0.804	0.003	<0.001	<0.001	<0.001

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