A novel positive end-expiratory pressure titration using electrical impedance tomography in spontaneously breathing acute respiratory distress syndrome patients on mechanical ventilation: an observational study from the MaastrICCht cohort.

Autor: Heines SJH; Department of Intensive Care, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, Maastricht, 6202, AZ, The Netherlands. S.heines@mumc.nl., de Jongh SAM; Department of Intensive Care, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, Maastricht, 6202, AZ, The Netherlands., de Jongh FHC; Department of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands., Segers RPJ; Department of Intensive Care, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, Maastricht, 6202, AZ, The Netherlands., Gilissen KMH; Department of Intensive Care, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, Maastricht, 6202, AZ, The Netherlands., van der Horst ICC; Department of Intensive Care, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, Maastricht, 6202, AZ, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands., van Bussel BCT; Department of Intensive Care, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, Maastricht, 6202, AZ, The Netherlands.; Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands., Bergmans DCJJ; Department of Intensive Care, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, Maastricht, 6202, AZ, The Netherlands.; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of clinical monitoring and computing [J Clin Monit Comput] 2024 Aug 28. Date of Electronic Publication: 2024 Aug 28.
DOI: 10.1007/s10877-024-01212-8
Abstrakt: There is no universally accepted method for positive end expiratory pressure (PEEP) titration approach for patients on spontaneous mechanical ventilation (SMV). Electrical impedance tomography (EIT) guided PEEP-titration has shown promising results in controlled mechanical ventilation (CMV), current implemented algorithm for PEEP titration (based on regional compliance measurements) is not applicable in SMV. Regional peak flow (RPF, defined as the highest inspiratory flow rate based on EIT at a certain PEEP level) is a new method for quantifying regional lung mechanics designed for SMV. The objective is to study whether RPF by EIT is a feasible method for PEEP titration during SMV. Single EIT measurements were performed in COVID-19 ARDS patients on SMV. Clinical (i.e., tidal volume, airway occlusion pressure, end-tidal CO 2 ) and mechanical (cyclic alveolar recruitment, recruitment, cumulative overdistension (OD), cumulative collapse (CL), pendelluft, and PEEP) outcomes were determined by EIT at several pre-defined PEEP thresholds (1-10% CL and the intersection of the OD and CL curves) and outcomes at all thresholds were compared to the outcomes at baseline PEEP. In total, 25 patients were included. No significant and clinically relevant differences were found between thresholds for tidal volume, end-tidal CO 2 , and P0.1 compared to baseline PEEP; cyclic alveolar recruitment rates changed by -3.9% to -37.9% across thresholds; recruitment rates ranged from - 49.4% to + 79.2%; cumulative overdistension changed from - 75.9% to + 373.4% across thresholds; cumulative collapse changed from 0% to -94.3%; PEEP levels from 10 up to 14 cmH 2 O were observed across thresholds compared to baseline PEEP of 10 cmH 2 O. A threshold of approximately 5% cumulative collapse yields the optimum compromise between all clinical and mechanical outcomes. EIT-guided PEEP titration by the RPF approach is feasible and is linked to improved overall lung mechanics) during SMV using a threshold of approximately 5% CL. However, the long-term clinical safety and effect of this approach remain to be determined.
(© 2024. The Author(s).)
Databáze: MEDLINE
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