Background: Positive end-expiratory pressure (PEEP) is a key element of mechanical ventilation. It should optimize recruitment, without causing excessive overdistension, but controversy exists on the best method to set it. The purpose of the study was to test the feasibility of setting PEEP with electrical impedance tomography in order to prevent lung de-recruitment following a recruitment maneuver. We enrolled 16 patients undergoing mechanical ventilation with PaO2/FiO2 <300Â mmHg. In all patients, under constant tidal volume (6â8Â ml/kg) PEEP was set based on the PEEP/FiO2 table proposed by the ARDS network (PEEPARDSnet). We performed a recruitment maneuver and monitored the end-expiratory lung impedance (EELI) over 10Â min. If the EELI signal decreased during this period, the recruitment maneuver was repeated and PEEP increased by 2Â cmH2O. This procedure was repeated until the EELI maintained a stability over time (PEEPEIT). Results: The procedure was feasible in 87% patients. PEEPEIT was higher than PEEPARDSnet (13Â Â±Â 3 vs. 9Â Â±Â 2Â cmH2O, pÂ <Â 0.001). PaO2/FiO2 improved during PEEPEIT and driving pressure decreased. Recruited volume correlated with the decrease in driving pressure but not with oxygenation improvement. Finally, regional alveolar hyperdistention and collapse was reduced in dependent lung layers and increased in non-dependent lung layers. Conclusions: In hypoxemic patients, a PEEP selection strategy aimed at stabilizing alveolar recruitment guided by EIT at the bedside was feasible and safe. This strategy led, in comparison with the ARDSnet table, to higher PEEP, improved oxygenation and reduced driving pressure, allowing to estimate the relative weight of overdistension and recruitment.
Bedside selection of positive end-expiratory pressure by electrical impedance tomography in hypoxemic patients : a feasibility study / N. Eronia, T. Mauri, E. Maffezzini, S. Gatti, A. Bronco, L. Alban, F. Binda, T. Sasso, C. Marenghi, G. Grasselli, G. Foti, A. Pesenti, G. Bellani. - In: ANNALS OF INTENSIVE CARE. - ISSN 2110-5820. - 7:1(2017), pp. 76.1-76.10.
|Titolo:||Bedside selection of positive end-expiratory pressure by electrical impedance tomography in hypoxemic patients : a feasibility study|
MAURI, TOMMASO (Secondo)
PESENTI, ANTONIO (Penultimo)
|Parole Chiave:||EIT; Overdistension; PEEP; Recruitment; Critical Care and Intensive Care Medicine|
|Settore Scientifico Disciplinare:||Settore MED/41 - Anestesiologia|
|Data di pubblicazione:||2017|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1186/s13613-017-0299-9|
|Appare nelle tipologie:||01 - Articolo su periodico|