Electrical Impedance Tomography and Prone Position During Ventilation in COVID-19 Pneumonia: Case Reports and a Brief Literature Review

Tomasino, S; Sassanelli, Rosa; Marescalco, Corrado; Meroi, Francesco; Vetrugno, Luigi; Bove, Tiziana

doi:10.1177/1089253220958912

Cited by 27 publications

(32 citation statements)

References 23 publications

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“…In this case series, different characteristics of the regional ventilation profile were evidenced by EIT that was thus helpful in understanding the etiology of hypoxemia at the bedside. Tomasino et al (2020) used EIT to identify the characteristics of COVID-19 pneumonia and to decide whether to use high PEEP or prone positioning.…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study on Electrical Impedance Tomography During CPAP Trial in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: The Bright Side of Non-invasive Ventilation

et al. 2021

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Background: Different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia phenotypes were described that match with different lung compliance and level of oxygenation, thus requiring a personalized ventilator setting. The burden of so many patients and the lack of intensive care unit (ICU) beds often force physicians to choose non-invasive ventilation (NIV) as the first approach, even if no consent has still been reached to discriminate whether it is safer to choose straightforward intubation, paralysis, and protective ventilation. Under such conditions, electrical impedance tomography (EIT), a non-invasive bedside tool to monitor lung ventilation and perfusion defects, could be useful to assess the response of patients to NIV and choose rapidly the right ventilatory strategy.Objective: The rationale behind this study is that derecruitment is a more efficient measure of positive end expiratory pressure (PEEP)-dependency of patients than recruitment. We hypothesized that patients who derecruit significantly when PEEP is reduced are the ones that do not need early intubation while small end-expiratory lung volume (ΔEELV) variations after a single step of PEEP de-escalation could be predictive of NIV failure.Materials and Methods: Consecutive patients admitted to ICU with confirmed SARS-CoV-2 pneumonia ventilated in NIV were enrolled. Exclusion criteria were former intubation or NIV lasting > 72 h. A trial of continuos positive airway pressure (CPAP) 12 was applied in every patient for at least 15 min, followed by the second period of CPAP 6, either in the supine or prone position. Besides standard monitoring, ventilation of patients was assessed by EIT, and end-expiratory lung impedance (ΔEELI) (%) was calculated as the difference in EELI between CPAP12 and CPAP6. Tidal volume (Vt), Ve, respiratory rate (RR), and FiO2 were recorded, and ABGs were measured. Data were analyzed offline using the dedicated software. The decision to intubate or continue NIV was in charge of treating physicians, independently from study results. Outcomes of patients in terms of intubation rate and ICU mortality were recorded.Results: We enrolled 10 male patients, with a mean age of 67 years. Six patients (60%) were successfully treated by NIV until ICU discharge (Group S), and four patients failed NIV and were intubated and switched to MV (Group F). All these patients died in ICU. During the supine CPAP decremental trial, all patients experienced an increase in RR and Ve. ΔEELI was < 40% in Group F and > 50% in Group S. In the prone trial, ΔEELI was > 50% in all patients, while RR decreased in Group S and remained unchanged in Group F.Conclusion: ΔEELI < 40% after a single PEEP de-escalation step in supine position seems to be a good predictor of poor recruitment and CPAP failure.

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Section: Discussionmentioning

confidence: 99%

A Pilot Study on Electrical Impedance Tomography During CPAP Trial in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: The Bright Side of Non-invasive Ventilation

et al. 2021

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“…Lung ultrasound (LU) is a well-established diagnostic tool in acute respiratory failure, and it is particularly suited for identification, grading, and follow-up of lung involvement severity [3,4,5]. In critically ill COVID-19 patients, LU is an alternative to chest radiography, chest CT or electric impedance tomography to quantify pulmonary impairment, follow lung involvement changes, or predict an intensive care unit (ICU) stay of more than 30 days or death [6,7,8]. Since medical personal involved in COVID-19 patients' treatment wear special protective equipment that increases the workload dramatically through temperature imbalance, touch impairment, communication problems, and visual difficulties.…”

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confidence: 99%

Lung Ultrasound Score in Critically Ill COVID-19 Patients: A Waste of Time or a Time-Saving Tool?

et al. 2021

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“…COVID-19 pneumonia requires different ventilator strategies. For patients who have VQ mismatch, EIT could assist in identifying different pneumonia patterns and setting optimal parameters on a mechanical ventilator [ 45 ]. COVID-19 patients often have airway secretions that severely compromise ventilation.…”

Section: Imaging Modalitiesmentioning

confidence: 99%

Imaging Pulmonary Blood Vessels and Ventilation-Perfusion Mismatch in COVID-19

2022

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COVID-19 hypoxemic patients although sharing a same etiology (SARS-CoV-2 infection) present themselves quite differently from one another. Patients also respond differently to prescribed medicine and to prone Vs supine bed positions. A severe pulmonary ventilation-perfusion mismatch usually triggers moderate to severe COVID-19 cases. Imaging can aid the physician in assessing severity of COVID-19. Although useful for their portability X-ray and ultrasound serving on the frontline to evaluate lung parenchymal abnormalities are unable to provide information about pulmonary vasculature and blood flow redistribution which is a consequence of hypoxemia in COVID-19. Advanced imaging modalities such as computed tomography, single-photon emission tomography, and electrical impedance tomography use a sharp algorithm visualizing pulmonary ventilation-perfusion mismatch in the abnormal and in the apparently normal parenchyma. Imaging helps to access the severity of infection, lung performance, ventilation-perfusion mismatch, and informs strategies for medical treatment. This review summarizes the capacity of these imaging modalities to assess ventilation-perfusion mismatch in COVID-19. Despite having limitations, these modalities provide vital information on blood volume distribution, pulmonary embolism, pulmonary vasculature and are useful to assess severity of lung disease and effectiveness of treatment in COVID-19 patients.

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Electrical Impedance Tomography and Prone Position During Ventilation in COVID-19 Pneumonia: Case Reports and a Brief Literature Review

Cited by 27 publications

References 23 publications

A Pilot Study on Electrical Impedance Tomography During CPAP Trial in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: The Bright Side of Non-invasive Ventilation

A Pilot Study on Electrical Impedance Tomography During CPAP Trial in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: The Bright Side of Non-invasive Ventilation

Lung Ultrasound Score in Critically Ill COVID-19 Patients: A Waste of Time or a Time-Saving Tool?

Imaging Pulmonary Blood Vessels and Ventilation-Perfusion Mismatch in COVID-19

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