Regional overdistension during prone positioning in a patient with acute respiratory failure who was ventilated with a low tidal volume: a case report

Kotani, Toru; Hanaoka, Masanori; Hirahara, Shinya; Yamanaka, Hisashi; Teschner, Eckhard; Shono, Atsuko

doi:10.1186/s40560-018-0290-z

Cited by 10 publications

(8 citation statements)

References 13 publications

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“…This intervention influences regional lung ventilation by changing the body position. The previous studies have used EIT to monitor the ventilation improvement during the body position changes ( 4 – 6 , 28 , 29 ) and have proven the feasibility of EIT. Hough et al ( 4 ) confirmed that body position changes might influence the regional ventilation distribution in infants, whereas van der Burg et al ( 5 ) did not find any differences between the lateral and supine positions.…”

Section: Discussionmentioning

confidence: 99%

Effect of Position Change From the Bed to a Wheelchair on the Regional Ventilation Distribution Assessed by Electrical Impedance Tomography in Patients With Respiratory Failure

et al. 2021

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Background: There is limited knowledge about the effect of position change on regional lung ventilation in patients with respiratory failure. This study aimed to examine the physiological alteration of regional lung ventilation during the position change from lying in bed to sitting on a wheelchair.Methods: In this study, 41 patients with respiratory failure who were weaned from the ventilators were prospectively enrolled. The electrical impedance tomography (EIT) was used to assess the regional lung ventilation distribution at four time points (Tbase: baseline, supine position in the bed, T30min: sitting position in the wheelchair after 30 min, T60min: sitting position in the wheelchair after 60 min, Treturn: the same supine position in the bed after position changing). The EIT-based global inhomogeneity (GI) and center of ventilation (CoV) indices were calculated. The EIT images were equally divided into four ventral-to-dorsal horizontal regions of interest (ROIs 1–4). Depending on the improvement in ventilation distribution in the dependent regions at T60min (threshold set to 15%), the patients were divided into the dorsal ventilation improved (DVI) and not improved (non-DVI) groups.Results: When the patients moved from the bed to a wheelchair, there was a significant and continuous increase in ventilation in the dorsal regions (ROI 3 + 4: 45.9 ± 12.1, 48.7 ± 11.6, 49.9 ± 12.6, 48.8 ± 10.6 for Tbase, T30min, T60min, and Treturn, respectively; p = 0.015) and CoV (48.2 ± 10.1, 50.1 ± 9.2, 50.5 ± 9.6, and 49.5 ± 8.6, p = 0.047). In addition, there was a significant decrease in GI at T60min compared with Tbase. The DVI group (n = 18) had significantly higher oxygenation levels than the non-DVI group (n = 23) after position changing. ROI4Tbase was significantly negatively correlated with the ΔSpO2 (R = 0.72, p < 0.001). Using a cutoff value of 6.5%, ROI4Tbase had 79.2% specificity and 58.8% sensitivity in indicating the increase in the dorsal region related to the position change. The corresponding area under the curve (AUC) was 0.806 (95% CI, 0.677–0.936).Conclusions: Position change may improve the ventilation distribution in the study patients. The EIT can visualize real-time changes of the regional lung ventilation at the bedside to guide the body position change of the patients in the intensive care unit (ICU) and measure the effect of clinical practice.Trial Registration: Effect of Early Mobilization on Regional Lung Ventilation Assessed by EIT, NCT04081129. Registered 9 June 2019—Retrospectively registered. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00096WT&selectaction=Edit&uid=U00020D9&ts=2&cx=v2cwij.

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Section: Discussionmentioning

confidence: 99%

Effect of Position Change From the Bed to a Wheelchair on the Regional Ventilation Distribution Assessed by Electrical Impedance Tomography in Patients With Respiratory Failure

et al. 2021

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“…Early mobilization in uences regional lung ventilation by body position changing. Previous researches have used EIT to monitor ventilation improvement during body position changing [23][24][25][26][27] and proved EIT's feasibility. Hough et al [24] con rmed that body position changes might in uence regional ventilation distribution in infants, whereas Pauline S et al [25] reported no difference between lateral and supine positioning.…”

Section: Eit On Regional Lung Ventilationmentioning

confidence: 99%

Effect of Early Mobilization from Bed to Wheel Chair on Regional Ventilation Distribution Assessed by Electrical Impedance Tomography in Respiratory Failure Patients

Yuan

Long

et al. 2020

Preprint

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Backgrounds: There was limited knowledge about the effect of early mobilization on regional lung ventilation in patients with respiratory failure. The aim of the study was to examine whether electrical impedance tomography (EIT) could help to predict the improvement in ventilation distribution due to mobilization.Methods: Forty-one patients with respiratory failure, who had weaned from ventilator and received early mobilization were prospectively enrolled in this study. EIT was used to assess regional lung ventilation distributions at 4 timepoints during the early mobilization from bed to wheelchair (Tbase: baseline, supine position at the bed, T30min: sitting position on the wheelchair after 30min, T60min: sitting position on the wheelchair after 60min, Treturn: return to supine position on the bed after early mobilization). The EIT-based global inhomogeneity (GI) and center of ventilation (CoV) indices were calculated. EIT images were equally divided into four ventral-to-dorsal horizontal regions of interest (ROIs 1-4). Depending on the improvement of ventilation distribution in dependent regions at T60min (threshold set to 15%), patients were divided into recruited (DR) and non-recruited (Non-DR) groups. Results: From the bed to the wheelchair, a significant and continuous increase of dependent regional ventilation distribution (ROI 3+4: baseline vs. T30min, vs. T60min: 45.9±12.1 vs. 48.7±11.6 vs. 49.9±12.6, p=0.015) and COV (COV baseline vs. T30min, vs. T60min: 48.2±10.1 vs. 50.1±9.2 vs. 50.5±9.6, p=0.003). Besides, there was a significant decrease of GI at T60min. Patients in the DR group (n=18) had significantly higher oxygenation than the Non-DR group (n=23) after early mobilization. ROI4Tbase was significantly negatively correlated to ΔSpO2 (R=0.72, p＜0.001). Using a cut-off value of 6.5%, ROI4Tbase had a 79.2% specificity and 58.8% sensitivity to predict response of dependent region recruitment due to early mobilization. The corresponding area under curve was 0.806 (95%CI, 0.677-0.936).Conclusions: EIT may be a promising tool to predict the ventilation improvement resulted from early mobilization.Trial registration: Effect of Early Mobilization on Regional Lung Ventilation Assessed by EIT, NCT04081129. Registered 9 June 2019 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00096WT&selectaction=Edit&uid=U00020D9&ts=2&cx=v2cwij

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“…A recent clinical case reported HENC could cause pulmonary hyperinflation with mild pneumomediastinum assessed by high-resolution chest computed tomography scan [8] in a patient with bronchiolitis obliterans syndrome. Moreover, Kotani et al reported the regional overdistension was detected at a prone position in an ARDS patient with a low tidal volume [9]. We proposed a novel EIT method to assess lung overdistension in the spontaneous breath condition [1].…”

Section: Huaiwu He Yun Longmentioning

confidence: 99%

Is the effect of a high-flow nasal cannula after extubation evaluated by electrical impedance tomography applicable to clinical practice?

Matsuda

2020

Crit Care

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Regional overdistension during prone positioning in a patient with acute respiratory failure who was ventilated with a low tidal volume: a case report

Cited by 10 publications

References 13 publications

Effect of Position Change From the Bed to a Wheelchair on the Regional Ventilation Distribution Assessed by Electrical Impedance Tomography in Patients With Respiratory Failure

Effect of Position Change From the Bed to a Wheelchair on the Regional Ventilation Distribution Assessed by Electrical Impedance Tomography in Patients With Respiratory Failure

Effect of Early Mobilization from Bed to Wheel Chair on Regional Ventilation Distribution Assessed by Electrical Impedance Tomography in Respiratory Failure Patients

Is the effect of a high-flow nasal cannula after extubation evaluated by electrical impedance tomography applicable to clinical practice?

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