Electrical Impedance Tomography Identifies Evolution of Regional Perfusion in a Porcine Model of Acute Respiratory Distress Syndrome.

Autor:	Martin KT; Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania., Xin Y; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts., Gaulton TG; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts., Victor M; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Electronics Engineering Division, Aeronautics Institute of Technology, São Paulo, Brazil., Santiago RR; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts., Kim T; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania., Morais CCA; Department of Physical Therapy, Federal University of Pernambuco, Recife, Brazil., Kazimi AA; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania., Connell M; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania; University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania., Gerard SE; Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa., Herrmann J; Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa., Mueller AL; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts., Lenart A; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania., Shen J; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania., Khan SS; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania., Petrov M; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania., Reutlinger K; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania., Rozenberg K; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania., Amato M; Department of Cardio-Pulmonary, University of São Paulo, São Paulo, Brazil., Berra L; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts., Cereda M; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	Anesthesiology [Anesthesiology] 2023 Dec 01; Vol. 139 (6), pp. 815-826.
DOI:	10.1097/ALN.0000000000004731
Abstrakt:	Background: Bedside electrical impedance tomography could be useful to visualize evolving pulmonary perfusion distributions when acute respiratory distress syndrome worsens or in response to ventilatory and positional therapies. In experimental acute respiratory distress syndrome, this study evaluated the agreement of electrical impedance tomography and dynamic contrast-enhanced computed tomography perfusion distributions at two injury time points and in response to increased positive end-expiratory pressure (PEEP) and prone position. Methods: Eleven mechanically ventilated (VT 8 ml · kg-1) Yorkshire pigs (five male, six female) received bronchial hydrochloric acid (3.5 ml · kg-1) to invoke lung injury. Electrical impedance tomography and computed tomography perfusion images were obtained at 2 h (early injury) and 24 h (late injury) after injury in supine position with PEEP 5 and 10 cm H2O. In eight animals, electrical impedance tomography and computed tomography perfusion imaging were also conducted in the prone position. Electrical impedance tomography perfusion (QEIT) and computed tomography perfusion (QCT) values (as percentages of image total) were compared in eight vertical regions across injury stages, levels of PEEP, and body positions using mixed-effects linear regression. The primary outcome was agreement between QEIT and QCT, defined using limits of agreement and Pearson correlation coefficient. Results: Pao2/Fio2 decreased over the course of the experiment (healthy to early injury, -253 [95% CI, -317 to -189]; early to late injury, -88 [95% CI, -151 to -24]). The limits of agreement between QEIT and QCT were -4.66% and 4.73% for the middle 50% quantile of average regional perfusion, and the correlation coefficient was 0.88 (95% CI, 0.86 to 0.90]; P < 0.001). Electrical impedance tomography and computed tomography showed similar perfusion redistributions over injury stages and in response to increased PEEP. QEIT redistributions after positional therapy underestimated QCT in ventral regions and overestimated QCT in dorsal regions. Conclusions: Electrical impedance tomography closely approximated computed tomography perfusion measures in experimental acute respiratory distress syndrome, in the supine position, over injury progression and with increased PEEP. Further validation is needed to determine the accuracy of electrical impedance tomography in measuring perfusion redistributions after positional changes. (Copyright © 2023 American Society of Anesthesiologists. All Rights Reserved.)
Databáze:	MEDLINE
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