Lung aeration and ventilation after percutaneous tracheotomy measured by electrical impedance tomography in non-hypoxemic critically ill patients: a prospective observational study

Autor:	Jakob Mueller, Jörn Grensemann, Stefan Kluge, Inéz Frerichs, Christian Zöllner, Lars Eichler
Rok vydání:	2018
Předmět:	Suction (medicine) Mechanical ventilation Lung Supine position business.industry medicine.medical_treatment Research lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine lcsh:RC86-88.9 Oxygenation Critical Care and Intensive Care Medicine Pulmonary function testing 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Tracheotomy 030228 respiratory system Anesthesia medicine Breathing business
Zdroj:	Annals of Intensive Care Annals of Intensive Care, Vol 8, Iss 1, Pp 1-8 (2018)
ISSN:	2110-5820
Popis:	Background Percutaneous dilatational tracheotomy (PDT) may lead to transient impairment of pulmonary function due to suboptimal ventilation, loss of positive end-expiratory pressure (PEEP) and repetitive suction maneuvers during the procedure. Possible changes in regional lung aeration were investigated using electrical impedance tomography (EIT), an increasingly implied instrument for bedside monitoring of pulmonary aeration. Methods With local ethics committee approval, after obtaining written informed consent 29 patients scheduled for elective PDT under bronchoscopic control were studied during mechanical ventilation in supine position. Anesthetized patients were monitored with a 16-electrode EIT monitor for 2 min at four time points: (a) before and (b) after initiation of neuromuscular blockade (NMB), (c) after dilatational tracheostomy (PDT) and (d) after a standardized recruitment maneuver (RM) following surgery, respectively. Possible changes in lung aeration were detected by changes in end-expiratory lung impedance (Δ EELI). Global and regional ventilation was characterized by analysis of tidal impedance variation. Results While NMB had no detectable effect on EELI, PDT led to significantly reduced EELI in dorsal lung regions as compared to baseline, suggesting reduced regional aeration. This effect could be reversed by a standardized RM. Mean delta EELI from baseline (SE) was: NMB − 47 ± 62; PDT − 490 ± 180; RM − 89 ± 176, values shown as arbitrary units (a.u.). Analysis of regional tidal impedance variation, a robust measure of regional ventilation, did not show significant changes in ventilation distribution. Conclusion Though changes of EELI might suggest temporary loss of aeration in dorsal lung regions, PDT does not lead to significant changes in either regional ventilation distribution or oxygenation.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a72b67f6d6afd19db824369bf02bc337 https://pubmed.ncbi.nlm.nih.gov/30443867 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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