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首页> 外文期刊>Critical care : >Bedside measurement of changes in lung impedance to monitor alveolar ventilation in dependent and non-dependent parts by electrical impedance tomography during a positive end-expiratory pressure trial in mechanically ventilated intensive care unit patient
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Bedside measurement of changes in lung impedance to monitor alveolar ventilation in dependent and non-dependent parts by electrical impedance tomography during a positive end-expiratory pressure trial in mechanically ventilated intensive care unit patient

机译：在机械通气的重症监护室患者进行呼气末正压试验时，通过电阻抗断层扫描在床旁测量肺阻抗的变化，以监测依赖和不依赖部位的肺泡通气

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IntroductionAs it becomes clear that mechanical ventilation can exaggerate lung injury, individual titration of ventilator settings is of special interest. Electrical impedance tomography (EIT) has been proposed as a bedside, regional monitoring tool to guide these settings. In the present study we evaluate the use of ventilation distribution change maps (ΔfEIT maps) in intensive care unit (ICU) patients with or without lung disorders during a standardized decremental positive end-expiratory pressure (PEEP) trial.MethodsFunctional EIT (fEIT) images and PaO2/FiO2 ratios were obtained at four PEEP levels (15 to 10 to 5 to 0 cm H2O) in 14 ICU patients with or without lung disorders. Patients were pressure-controlled ventilated with constant driving pressure. fEIT images made before each reduction in PEEP were subtracted from those recorded after each PEEP step to evaluate regional increase/decrease in tidal impedance in each EIT pixel (ΔfEIT maps).ResultsThe response of regional tidal impedance to PEEP showed a significant difference from 15 to 10 (P = 0.002) and from 10 to 5 (P = 0.001) between patients with and without lung disorders. Tidal impedance increased only in the non-dependent parts in patients without lung disorders after decreasing PEEP from 15 to 10 cm H2O, whereas it decreased at the other PEEP steps in both groups.ConclusionsDuring a decremental PEEP trial in ICU patients, EIT measurements performed just above the diaphragm clearly visualize improvement and loss of ventilation in dependent and non-dependent parts, at the bedside in the individual patient.
机译：引言很明显，机械通气会加剧肺损伤，因此特别需要对呼吸机设置进行个体化滴定。已经提出了电阻抗断层扫描（EIT）作为床头区域指导工具来指导这些设置。在本研究中，我们评估在标准化的递减呼气末正压（PEEP）试验中，在有或没有肺部疾病的重症监护病房（ICU）患者中使用通气分布变化图（ΔfEIT图）。在14例有或没有肺部疾病的ICU患者中，在四种PEEP水平（15至10至5至0至0 cm H2O）下获得了PaO2 / FiO2和PaO2 / FiO2的比率。在恒定的驱动压力下对患者进行压力控制通气。从每个PEEP步骤之后记录的图像中减去在每次PEEP降低之前拍摄的fEIT图像，以评估每个EIT像素的潮汐阻抗的区域增加/减小（ΔfEIT图）。结果区域潮汐阻抗对PEEP的响应在15到15之间有显着差异。有和没有肺部疾病的患者之间的差异为10（P = 0.002），从10到5（P = 0.001）。在PEEP从15 cm H2O降低到10 cm H2O后，潮气阻抗仅在无肺部疾病的患者的非依赖性部位增加，而在两组中，其在其他PEEP步骤均降低。结论在ICU患者的PEEP递减试验中，仅进行了EIT测量横diaphragm膜上方清楚地显示出各个患者床旁依赖和不依赖部位的改善和通气损失。

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