Real‐time ventilation and perfusion distributions by electrical impedance tomography during one‐lung ventilation with capnothorax

Reinius, Henrik; Borges, João Batista; Fredén, Filip; Jidéus, Lena; Camargo, Erick Dario León Bueno de; Amato, Marcelo B. P.; Hedenstierna, Göran; Larsson, Anders; Lennmyr, Fredrik

doi:10.1111/aas.12455

Cited by 49 publications

(34 citation statements)

References 44 publications

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“…In diverse clinical studies, the potential of EIT in monitoring settings of positive end-expiratory pressure (PEEP) for analysis of lung recruitability and for avoidance of ventilator-induced lung injury is a particular focus [4–7]. Moreover, other different clinical scenarios, such as one-lung ventilation, lung edema, endotracheal suctioning, or spontaneous breathing, have proven the usability of EIT [8–11]. …”

Section: Introductionmentioning

confidence: 99%

Electrical impedance tomography for predicting failure of spontaneous breathing trials in patients with prolonged weaning

et al. 2017

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BackgroundSpontaneous breathing trials (SBTs) on a T-piece can be difficult in patients with prolonged weaning because of remaining de-recruitment phenomena and/or insufficient ventilation. There is no clinically established method existent other than experience for estimating whether an SBT is most probably beneficial. Electrical impedance tomography (EIT) is a clinical useful online monitoring technique during mechanical ventilation, particularly because it enables analysis of effects of regional ventilation distribution. The aim of our observational study was to examine if EIT can predict whether patients with prolonged weaning will benefit from a planned SBT.MethodsThirty-one patients were examined. Blood gas analysis, vital parameter measurements, and EIT recordings were performed at three time points: (1) baseline with pressure support ventilation (PSV) (t0), (2) during a T-piece trial (t1), and (3) after resumption of PSV (t2). Calculation of EIT parameters was performed, including the impedance ratio (IR), the tidal variation of impedance (TIV), the changes in end-expiratory lung impedance (ΔEELI), the global inhomogeneity index (GI), and the regional ventilation delay (RVD) index with use of different thresholds of the percentage inspiration time (RVD40, RVD60, RVD80). The predictive power of the baseline GI with regard to clinical impairment of an SBT was analyzed by means of ROC curves. Clinical deterioration was assumed when tidal volume was decreased by at least 20 ml after the T-piece trial, measured at t2.ResultsPartial pressure of arterial oxygen significantly decreased at t1 (71 ± 15 mmHg) compared with t0 (85 ± 17 mmHg, p < 0.05) and t2 (82 ± 18 mmHg, p < 0.05). The IR trended toward higher values during t1. At t1, TIV and ΔEELI significantly decreased. The GI was significantly increased at t1 (t0 59.3 ± 46.1 vs t1 81.5 ± 62.5, p = 0.001), as were all RVD indexes. Assuming a GI cutoff value of >40, sensitivity of 85% and specificity of 50% were reached for predicting an increased future tidal volume.ConclusionsEIT enables monitoring of regional ventilation distribution during SBTs and is suitable to estimate whether an SBT probably will be beneficial for an individual patient. Therefore, the application of EIT can support clinical decisions regarding patients in the phase of prolonged weaning.

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Section: Introductionmentioning

confidence: 99%

Electrical impedance tomography for predicting failure of spontaneous breathing trials in patients with prolonged weaning

et al. 2017

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“…With an insufflation pressure of 16 cm H 2 O a PEEP between 12 and 18 cm H 2 O was not only optimal for the ventilatory parameters but also for the hemodynamics. 82 [14] 82 [11] 72 [15] 70 [18] 81 [7] 83 [9] 81 [12] 76 [11] 77 [7] 74 [12] 65 [14] 68 [21] 63 [15] 0.005 SvO 2 (%) 73 [8] 44 [9] 46 [14] 54 [17] 54 [7] 60 [9] 61 [13] 52 [9] 54 [6] 43 [9] 37 [17] 33 [15] 28 [16] <0.0001…”

Section: Discussionmentioning

confidence: 99%

“…We have developed a porcine model that reproduces this clinical scenario in order to test and optimize different cardiopulmonary interventions. 12 Key factors that need to be monitored and optimized include complete lung separation, gas exchange, and hemodynamic responses.…”

mentioning

confidence: 99%

Optimal PEEP during one‐lung ventilation with capnothorax: An experimental study

Reinius

Borges

Engström

et al. 2018

Acta Anaesthesiol Scand

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“…The state-of-the-art of EIT in critical care thoracic imaging is to image 2-D slices in the plane of a belt of electrodes placed around the thorax [5], [6], [7], [8], [9], [10]. Estimates of alveolar collapse and compliance can be determined from reconstructions of impedance changes in lung regions in these slices, and the gravitational vector inside the lung can be taken into account [11].…”

Section: Introductionmentioning

confidence: 99%

“…Estimates of alveolar collapse and compliance can be determined from reconstructions of impedance changes in lung regions in these slices, and the gravitational vector inside the lung can be taken into account [11]. Ventilation and perfusion maps can also be created in these slices in real time, providing a method of monitoring PEEP titration [7]. …”

Section: Introductionmentioning

confidence: 99%

Incorporating a Spatial Prior into Nonlinear D-Bar EIT Imaging for Complex Admittivities

Hamilton

Mueller

Alsaker

2017

IEEE Trans. Med. Imaging

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Electrical Impedance Tomography (EIT) aims to recover the internal conductivity and permittivity distributions of a body from electrical measurements taken on electrodes on the surface of the body. The reconstruction task is a severely ill-posed nonlinear inverse problem that is highly sensitive to measurement noise and modeling errors. Regularized D-bar methods have shown great promise in producing noise-robust algorithms by employing a low-pass filterin of nonlinear (nonphysical) Fourier transform data specifi to the EIT problem. Including prior data with the approximate locations of major organ boundaries in the scattering transform provides a means of extending the radius of the low-pass filte to include higher frequency components in the reconstruction, in particular, features that are known with high confidence This information is additionally included in the system of D-bar equations with an independent regularization parameter from that of the extended scattering transform. In this paper, this approach is used in the 2-D D-bar method for admittivity (conductivity as well as permittivity) EIT imaging. Noise-robust reconstructions are presented for simulated EIT data on chest-shaped phantoms with a simulated pneumothorax and pleural effusion. No assumption of the pathology is used in the construction of the prior, yet the method still produces significant enhancements of the underlying pathology (pneumothorax or pleural effusion) even in the presence of strong noise.

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Real‐time ventilation and perfusion distributions by electrical impedance tomography during one‐lung ventilation with capnothorax

Abstract: EIT detected in real-time dynamic changes in pulmonary ventilation and perfusion distributions. OLV to the left lung with right-sided capnothorax caused a decrease in cardiac output, arterial oxygenation and mixed venous saturation.

Cited by 49 publications

References 44 publications

Electrical impedance tomography for predicting failure of spontaneous breathing trials in patients with prolonged weaning

Electrical impedance tomography for predicting failure of spontaneous breathing trials in patients with prolonged weaning

Optimal PEEP during one‐lung ventilation with capnothorax: An experimental study

Incorporating a Spatial Prior into Nonlinear D-Bar EIT Imaging for Complex Admittivities

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