Mechanical Ventilation Guided by Electrical Impedance Tomography in Experimental Acute Lung Injury

被引：101

作者：

Wolf, Gerhard K. ^{[1
]}

Gomez-Laberge, Camille ^{[1
]}

Rettig, Jordan S. ^{[1
]}

Vargas, Sara O. ^{[2
]}

Smallwood, Craig D. ^{[3
]}

Prabhu, Sanjay P. ^{[4
]}

Vitali, Sally H. ^{[1
]}

Zurakowski, David ^{[1
]}

Arnold, John H. ^{[1
]}

机构：

[1] Harvard Univ, Boston Childrens Hosp, Sch Med, Dept Anesthesiol Perioperat & Pain Med,Div Crit C, Boston, MA 02115 USA

[2] Harvard Univ, Sch Med, Dept Pathol, Boston Childrens Hosp, Boston, MA 02115 USA

[3] Harvard Univ, Sch Med, Boston Childrens Hosp, Dept Resp Care, Boston, MA USA

[4] Harvard Univ, Sch Med, Dept Radiol, Boston Childrens Hosp, Boston, MA 02115 USA

来源：

CRITICAL CARE MEDICINE | 2013年 / 41卷 / 05期

关键词：

acute respiratory distress syndrome; electrical impedance tomography; lung; lung atelectasis; lung overdistension; RESPIRATORY-DISTRESS-SYNDROME; TIDAL VOLUME VENTILATION; END-EXPIRATORY PRESSURE; COMPUTED-TOMOGRAPHY; RECRUITMENT; COLLAPSE; HYPERINFLATION; CHILDREN; BEDSIDE; MODELS;

D O I：

10.1097/CCM.0b013e3182771516

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objective: To utilize real-time electrical impedance tomography to guide lung protective ventilation in an animal model of acute respiratory distress syndrome. Design: Prospective animal study. Setting: Animal research center. Subjects: Twelve Yorkshire swine (15 kg). Interventions: Lung injury was induced with saline lavage and augmented using large tidal volumes. The control group (n = 6) was ventilated using ARDSnet guidelines, and the electrical impedance tomography-guided group (n = 6) was ventilated using guidance with real-time electrical impedance tomography lung imaging. Regional electrical impedance tomography-derived compliance was used to maximize the recruitment of dependent lung and minimize overdistension of nondependent lung areas. Tidal volume was 6 mL/kg in both groups. Computed tomography was performed in a subset of animals to define the anatomic correlates of electrical impedance tomography imaging (n = 5). Interleukin-8 was quantified in serum and bronchoalveolar lavage samples. Sections of dependent and nondependent regions of the lung were fixed in formalin for histopathologic analysis. Measurements and Main Results: Positive end-expiratory pressure levels were higher in the electrical impedance tomography-guided group (14.3 cm H2O vs. 8.6 cm H2O; p < 0.0001), whereas plateau pressures did not differ. Global respiratory system compliance was improved in the electrical impedance tomography-guided group (6.9 mL/cm H2O vs. 4.7 mL/cm H2O; p = 0.013). Regional electrical impedance tomography-derived compliance of the most dependent lung region was increased in the electrical impedance tomography group (1.78 mL/cm H2O vs. 0.99 mL/cm H2O; p = 0.001). PaO2/FIO2 ratio was higher and oxygenation index was lower in the electrical impedance tomography-guided group (PaO2/FIO2: 388 mm Hg vs. 113 mm Hg, p < 0.0001; oxygentation index, 6.4 vs. 15.7; p = 0.02) (all averages over the 6-hr time course). The presence of hyaline membranes (HM) and airway fibrin (AF) was significantly reduced in the electrical impedance tomography-guided group (HMEIT 42% samples vs. HMCONTROL 67% samples, p < 0.01; AF(EIT) 75% samples vs. AF(CONTROL) 100% samples, p < 0.01). Interleukin-8 level (bronchoalveolar lavage) did not differ between the groups. The upper and lower 95% limits of agreement between electrical impedance tomography and computed tomography were +/- 16%. Conclusions: Electrical impedance tomography-guided ventilation resulted in improved respiratory mechanics, improved gas exchange, and reduced histologic evidence of ventilator-induced lung injury in an animal model. This is the first prospective use of electrical impedance tomography-derived variables to improve outcomes in the setting of acute lung injury. (Crit Care Med 2013; 41:1296-1304)

引用

页码：1296 / 1304

页数：9

共 42 条

[1] Electrical impedance tomography can monitor dynamic hyperinflation in dogs [J].