Regional distribution of blood volume within the preterm infant thorax during synchronised mechanical ventilation

Carlisle, Hazel; Armstrong, Ruth K.; Davis, Peter G; Schibler, Andreas; Frerichs, Inéz; Tingay, David G.

doi:10.1007/s00134-010-2049-4

Cited by 37 publications

(34 citation statements)

References 44 publications

(92 reference statements)

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“…A study in preterm infants showed that measuring changes in pulmonary blood volume by EIT was feasible and that the changes were greater in the non-dependent lung. 97 EIT has been used to demonstrate a decrease in global and regional pulmonary blood flow following ventricular septum defect repair in children. 98 Validation studies in infants and children are limited, because comparative monitoring with CT and radionuclide scanning is often not feasible or safe.…”

Section: Clinical Use Of Eit In Neonatal and Paediatric Patientsmentioning

confidence: 99%

Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group

Frerichs¹,

Amato

Kaam

et al. 2016

Thorax

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687

719

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Electrical impedance tomography (EIT) has undergone 30 years of development. Functional chest examinations with this technology are considered clinically relevant, especially for monitoring regional lung ventilation in mechanically ventilated patients and for regional pulmonary function testing in patients with chronic lung diseases. As EIT becomes an established medical technology, it requires consensus examination, nomenclature, data analysis and interpretation schemes. Such consensus is needed to compare, understand and reproduce study findings from and among different research groups, to enable large clinical trials and, ultimately, routine clinical use. Recommendations of how EIT findings can be applied to generate diagnoses and impact clinical decision-making and therapy planning are required. This consensus paper was prepared by an international working group, collaborating on the clinical promotion of EIT called TRanslational EIT developmeNt stuDy group. It addresses the stated needs by providing (1) a new classification of core processes involved in chest EIT examinations and data analysis, (2) focus on clinical applications with structured reviews and outlooks (separately for adult and neonatal/paediatric patients), (3) a structured framework to categorise and understand the relationships among analysis approaches and their clinical roles, (4) consensus, unified terminology with clinical user-friendly definitions and explanations, (5) a review of all major work in thoracic EIT and (6) recommendations for future development (193 pages of online supplements systematically linked with the chief sections of the main document). We expect this information to be useful for clinicians and researchers working with EIT, as well as for industry producers of this technology.

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Section: Clinical Use Of Eit In Neonatal and Paediatric Patientsmentioning

confidence: 99%

Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group

Frerichs¹,

Amato

Kaam

et al. 2016

Thorax

Self Cite

687

719

View full text Add to dashboard Cite

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“…The EIT recordings were referenced to the signal immediately prior to ventilation to determine relative change in impedance (ΔZ) from birth. EEV was then determined from the trough of the impedance signals after applying a low-pass filter at 10 breaths per minute above the second harmonic of the respiratory signal (respiratory domain) (34,37,38). Relative change in EEV from birth was then determined in the nondependant (ventral) and dependant (dorsal) hemithoraces.…”

Section: Stepwise Peep Vs Si At Birthmentioning

confidence: 99%

Effect of sustained inflation vs. stepwise PEEP strategy at birth on gas exchange and lung mechanics in preterm lambs

et al. 2013

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Background: Sustained inflation (SI) at birth facilitates establishment of functional residual capacity (FRC) in the preterm lung, but the ideal lung recruitment strategy is unclear. We have compared the effect of SI and a stepwise positive endexpiratory pressure (PEEP; SEP) strategy in a preterm model. Methods: 127 d gestation lambs received either 20-s SI (n = 9) or 2 cmH 2 O stepwise PEEP increases to 20 cmH 2 O every 10 inflations, and then decreases to 6 cmH 2 O (n = 10). Ventilation continued for 70 min, with surfactant administered at 10 min. Alveolar-arterial oxygen gradient (AaDO 2 ), compliance (C dyn ), end-expiratory thoracic volume (EEV RIP ; respiratory inductive plethysmography), and EEV and C dyn in the gravitydependent and nondependent hemithoraces (electrical impedance tomography) were measured throughout. Early mRNA markers of lung injury were analyzed using quantitative real-time PCR. results: From 15 min of life, AaDO2 was lower in SEP group (P < 0.005; two-way ANOVA). SEP resulted in higher and more homogeneous C dyn (P < 0.0001). Mean (SD) EEV RIP at 5 min was 18 (9) ml/kg and 6 (5) ml/kg following SEP and SI, respectively (P = 0.021; Bonferroni posttest); this difference was due to a greater nondependent hemithorax EEV. There was no difference in markers of lung injury. conclusion: An SEP at birth improved gas exchange, lung mechanics, and EEV, without increasing lung injury, compared to the SI strategy used.

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“…To isolate the end-expiratory volume (EEV), the trough of each respiratory cycle was determined after low-pass filtering the impedance signal to the respiratory domain [11-13,17]. The EIT data were divided into three regions of interest (ROI); the global and gravity-dependent (ventral) and non-dependent (dorsal) hemithoraces.…”

Section: Methodsmentioning

confidence: 99%

Pressure- versus volume-limited sustained inflations at resuscitation of premature newborn lambs

et al. 2014

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BackgroundSustained inflations (SI) are advocated for the rapid establishment of FRC after birth in preterm and term infants requiring resuscitation. However, the most appropriate way to deliver a SI is poorly understood. We investigated whether a volume-limited SI improved the establishment of FRC and ventilation homogeneity and reduced lung inflammation/injury compared to a pressure-limited SI.Methods131 d gestation lambs were resuscitated with either: i) pressure-limited SI (PressSI: 0-40 cmH2O over 5 s, maintained until 20 s); or ii) volume-limited SI (VolSI: 0-15 mL/kg over 5 s, maintained until 20 s). Following the SI, all lambs were ventilated using volume-controlled ventilation (7 mL/kg tidal volume) for 15 min. Lung mechanics, regional ventilation distribution (electrical impedance tomography), cerebral tissue oxygenation index (near infrared spectroscopy), arterial pressures and blood gas values were recorded regularly. Pressure-volume curves were performed in-situ post-mortem and early markers of lung injury were assessed.ResultsCompared to a pressure-limited SI, a volume-limited SI had increased pressure variability but reduced volume variability. Each SI strategy achieved similar end-inflation lung volumes and regional ventilation homogeneity. Volume-limited SI increased heart-rate and arterial pressure faster than pressure-limited SI lambs, but no differences were observed after 30 s. Volume-limited SI had increased arterial-alveolar oxygen difference due to higher FiO2 at 15 min (p = 0.01 and p = 0.02 respectively). No other inter-group differences in arterial or cerebral oxygenation, blood pressures or early markers of lung injury were evident.ConclusionWith the exception of inferior oxygenation, a sustained inflation targeting delivery to preterm lambs of 15 mL/kg volume by 5 s did not influence physiological variables or early markers of lung inflammation and injury at 15 min compared to a standard pressure-limited sustained inflation.

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Regional distribution of blood volume within the preterm infant thorax during synchronised mechanical ventilation

Abstract: There are gravity dependent differences in the distribution of blood volume and ventilation in the ventilated preterm chest.

Cited by 37 publications

References 44 publications

Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group

Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group

Effect of sustained inflation vs. stepwise PEEP strategy at birth on gas exchange and lung mechanics in preterm lambs

Pressure- versus volume-limited sustained inflations at resuscitation of premature newborn lambs

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