Application of regional recruitment-to-inflation ratio monitored by electrical impedance tomography in the models of acute respiratory distress syndrome

doi:10.3877/cma.j.issn.2096-1537.2022.04.014

Abstract

Abstract:

Objective

To observe the application of regional recruitment-to-inflation ratio (RI ratio) monitored by electrical impedance tomography (EIT) in the models of acute respiratory distress syndrome (ARDS).

Methods

ARDS models were established by intravenous infusion of oleic acid in 6 Bama pigs. The model was considered as being successfully established when the ratio of the partial pressure of oxygen in arterial blood PaO₂ to FiO₂ (PaO₂/FiO₂) remained below 200 mmHg for at least 30 min. After the ARDS model was established, a recruitment manuver (RM) was performed. After RM, the animal was ventilated at PEEP 15 cmH₂O for one hour. Then, a prolonged expiration was performed and PEEP was decreased from 15 to 5 cmH₂O. The process was monitored by EIT, and offline analysis was performed after the experiment. Lung images were divided into two ventral-to-dorsal horizontal regions of interest (ROI). Recruitment volume (Vrec), global RI ratio, regional Vrec and regional RI ratio were calculated by EIT.

Results

ARDS was successfully induced in all experimental animals with median (IQR) PaO₂/FiO₂ decreasing from (422.5±49.9) mmHg to (151.7±13.4) mmHg (t=14.100, P＜0.001). The median and interquartile range of the RI ratio of all experimental animals was 1.59 (1.42, 1.67). The global RI ratio, RI ratio of nondependent areas and dependent areas of 6 animals were 1.83, 1.03, 2.06; 1.68, 1.51, 2.28; 1.64, 0.98, 1.83; 1.23, 0.93, 1.33; 1.38, 0.02, 1.27; 1.55, 1.41, 1.99 respectively.

Conclusion

Regional RI ratio can be calculated and monitored by EIT in ARDS patients, which may provide more information on regional recruitability.

Key words: Electrical impedance tomography, Acute respiratory distress syndrome, Recruitment-to-inflation ratio, Prolonged expiration

Yumei Wang, Yan Wang, Yimin Zhou, Mingyue Miao, Yanlin Yang, Linlin Zhang, Ming Xu, Jianxin Zhou. Application of regional recruitment-to-inflation ratio monitored by electrical impedance tomography in the models of acute respiratory distress syndrome[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(04): 360-366.

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Figures/Tables 4

References 21

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指标	造模前（6只）	造模后（6只）	t值	P值
氧合指数（mmHg）	422.5±49.9	151.7±13.4	14.100	＜0.001
Vd/Vt（%）	13±7	19±9	2.122	0.087
MAP（mmHg）	139±23	106±23	3.165	0.025
HR（次/min）	57±20	70±38	1.518	0.189
MPAP（mmHg）	21±2	31±6	4.554	0.006
PAWP（mmHg）	9±3	11±3	3.606	0.015
CO（L/min）	2.8±0.4	2.9±0.7	0.393	0.710
Pplat（cmH₂O）	11.6±2.1	18.1±3.8	7.047	0.001
DP（cmH₂O）	8.4±2.3	14.6±3.4	8.711	＜0.001
Crs（ml/cmH₂O）	43.7±11.5	24.4±6.1	6.003	0.002
Crs-nondep（ml/cmH₂O）	31.7±9.7	18.7±5.0	5.263	0.003
Crs-dep（ml/cmH₂O）	11.5±4.4	5.7±1.4	3.588	0.160
Vt-nondep（ml）	251±23	260±29	0.715	0.507
Vt-dep（ml）	93±20	80±13	1.508	0.192
COV	27±9	23±4	1.209	0.281

指标	造模前（6只）	造模后（6只）	t值	P值
氧合指数（mmHg）	422.5±49.9	151.7±13.4	14.100	＜0.001
Vd/Vt（%）	13±7	19±9	2.122	0.087
MAP（mmHg）	139±23	106±23	3.165	0.025
HR（次/min）	57±20	70±38	1.518	0.189
MPAP（mmHg）	21±2	31±6	4.554	0.006
PAWP（mmHg）	9±3	11±3	3.606	0.015
CO（L/min）	2.8±0.4	2.9±0.7	0.393	0.710
Pplat（cmH₂O）	11.6±2.1	18.1±3.8	7.047	0.001
DP（cmH₂O）	8.4±2.3	14.6±3.4	8.711	＜0.001
Crs（ml/cmH₂O）	43.7±11.5	24.4±6.1	6.003	0.002
Crs-nondep（ml/cmH₂O）	31.7±9.7	18.7±5.0	5.263	0.003
Crs-dep（ml/cmH₂O）	11.5±4.4	5.7±1.4	3.588	0.160
Vt-nondep（ml）	251±23	260±29	0.715	0.507
Vt-dep（ml）	93±20	80±13	1.508	0.192
COV	27±9	23±4	1.209	0.281

指标	PEEP 5 cmH₂O	PEEP 15 cmH₂O	t值	P值
氧合指数（mmHg）	158.4±28.9	229.7±32.7	4.197	0.009
Vd/Vt（%）	23±12	19±7	1.119	0.314
MAP（mmHg）	102±21	102±29	<0.001	1.000
HR（次/min）	72±31	86±29	1.070	0.334
MPAP（mmHg）	34±7	33±3	0.484	0.649
PAWP（mmHg）	9±3	11±2	2.712	0.042
CO（L/min）	2.9±0.8	2.0±0.6	3.758	0.013
Pplat（cmH₂O）	18.4±3.8	25.1±2.7	8.764	＜0.001
DP（cmH₂O）	15.5±3.8	11.4±2.7	5.499	0.003
Vt-nondep（ml）	273±23	241±30	6.054	0.002
Vt-dep（ml）	76±11	103±21	4.387	0.007
Crs（ml/cmH₂O）	23.6±6.1	31.8±8.5	5.138	0.004
Crs-nondep（ml/cmH₂O）	18.5±5.0	22.4±6.8	2.911	0.033
Crs-dep（ml/cmH₂O）	5.1±1.3	9.5±2.8	6.268	0.002
COV	22±3	30±6	4.626	0.006

指标	PEEP 5 cmH₂O	PEEP 15 cmH₂O	t值	P值
氧合指数（mmHg）	158.4±28.9	229.7±32.7	4.197	0.009
Vd/Vt（%）	23±12	19±7	1.119	0.314
MAP（mmHg）	102±21	102±29	<0.001	1.000
HR（次/min）	72±31	86±29	1.070	0.334
MPAP（mmHg）	34±7	33±3	0.484	0.649
PAWP（mmHg）	9±3	11±2	2.712	0.042
CO（L/min）	2.9±0.8	2.0±0.6	3.758	0.013
Pplat（cmH₂O）	18.4±3.8	25.1±2.7	8.764	＜0.001
DP（cmH₂O）	15.5±3.8	11.4±2.7	5.499	0.003
Vt-nondep（ml）	273±23	241±30	6.054	0.002
Vt-dep（ml）	76±11	103±21	4.387	0.007
Crs（ml/cmH₂O）	23.6±6.1	31.8±8.5	5.138	0.004
Crs-nondep（ml/cmH₂O）	18.5±5.0	22.4±6.8	2.911	0.033
Crs-dep（ml/cmH₂O）	5.1±1.3	9.5±2.8	6.268	0.002
COV	22±3	30±6	4.626	0.006

编号	Vrec（ml）	Vrec-dep（ml）	Vrec-nondep（ml）	Crec（ml/cmH₂O）	Crec-dep（ml/cmH₂O）	Crec-nondep（ml/cmH₂O）
1	544	67	477	54.39	6.70	47.69
2	243	73	171	24.34	7.26	17.09
3	393	52	341	39.27	5.16	34.11
4	317	60	257	31.71	5.97	25.74
5	113	4	108	11.26	0.44	10.81
6	284	87	197	28.41	8.75	19.66

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