Clinical implementation of electric impedance tomography in the treatment of ARDS: a single centre experience

Abstract

To report on our clinical experience using EIT in individualized PEEP titration in ARDS. Using EIT assessment, we optimized PEEP settings in 39 ARDS patients. The EIT PEEP settings were compared with the physicians' PEEP settings and the PEEP settings according to the ARDS network. We defined a PEEP difference equal to or greater than 4 cm HO as clinically relevant. Changes in lung compliance and PaO/FiO-ratio were compared in patients with EIT-based PEEP adjustments and in patients with unaltered PEEP. In 28% of the patients, the difference in EIT-based PEEP and physician-PEEP was clinically relevant; in 36%, EIT-based PEEP and physician-PEEP were equal. The EIT-based PEEP disagreed with the PEEP settings according to the ARDS network. Adjusting PEEP based upon EIT led to a rapid increase in lung compliance and PaO/FiO-ratio. However, this increase was also observed in the group where the PEEP difference was less than 4 cm HO. We hypothesize that this can be attributed to the alveolar recruitment during the PEEP trial. EIT based individual PEEP setting appears to be a promising method to optimize PEEP in ARDS patients. The clinical impact, however, remains to be established.

Serial measurements in COVID-19-induced acute respiratory disease to unravel heterogeneity of the disease course: design of the Maastricht Intensive Care COVID cohort;MaastrICCht

“…In our department, chest EIT is performed by specialist ventilation practitioners and is available if considered indicated to support clinical practice in patients with respiratory failure and thus is not performed in each patient each day. [14] During the upscaling of COVID-19 ICU subunits, the team of ventilation practitioners was extended with trained medical research interns and technical physicians to cover serial chest EIT measurements in each of the six COVID ICU subunits. Data collection on chest EIT was supervised by the specialist ventilation practitioners.…”

“…For the MaastrICCht cohort, our specialist ventilation practitioner team will start the first chest EIT measurement in each admitted patient after intubation as soon as clinically and logistically possible. We intend to obtain measurements in every mechanically ventilated Netherlands, to enable pooling of chest EIT data in collaboration [11][12][13][14]29], and is described in the supplement.…”

“…We intend to use serial measurements to investigate the aetiology, diagnostic and prognostic value of respiratory variables (i.e. ventilator settings, prone positioning, chest electric impedance tomography (EIT)) [11][12][13][14], cardiovascular variables (laboratory variables, electrocardiograms, echocardiograms and chest computed tomography (CT) scans) [10], metabolic variables (kidney function, liver biochemistry and electrolytes) and thrombotic complications (laboratory variables, thrombotic events) amongst others as described below. We describe the design of the MaastrICCht cohort in detail.…”

Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trial

“…Previously described techniques for titrating PEEP (the decremental PEEP trial [30], dead space fraction [31], indices of regional ventilation [32][33][34], esophageal pressure [35], or other imaging techniques [36]), require additional equipment, involve an additional burden for the patient, or may per se not be available at the bedside. The techniques based on the determination of best PEEP from static respiratory system variables, such as the static pressure-volume curve, did not contribute to the dynamic intratidal changes in respiratory system mechanics [37].…”

Journal of Clinical Monitoring and Computing 2018–2019 end of year summary: respiration

“…Heines and coauthors [41] have studied the use of electrical impedance tomography (EIT) for defining the Positive end-expiratory pressure (PEEP) that should be applied to patients having the Acute Respiratory Distress Syndrome. The values obtained by EIT were compared to the ones derived by the PEEP/FiO 2 table used by the ARDS network and with the PEEP values proposed by the attending clinicians.…”