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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment

Authors: Savino Spadaro, Tommaso Mauri, Stephan H. Böhm, Gaetano Scaramuzzo, Cecilia Turrini, Andreas D. Waldmann, Riccardo Ragazzi, Antonio Pesenti, Carlo Alberto Volta

Published in: Critical Care | Issue 1/2018

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Abstract

Background

Assessing alveolar recruitment at different positive end-expiratory pressure (PEEP) levels is a major clinical and research interest because protective ventilation implies opening the lung without inducing overdistention. The pressure-volume (P-V) curve is a validated method of assessing recruitment but reflects global characteristics, and changes at the regional level may remain undetected. The aim of the present study was to compare, in intubated patients with acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS), lung recruitment measured by P-V curve analysis, with dynamic changes in poorly ventilated units of the dorsal lung (dependent silent spaces [DSSs]) assessed by electrical impedance tomography (EIT). We hypothesized that DSSs might represent a dynamic bedside measure of recruitment.

Methods

We carried out a prospective interventional study of 14 patients with AHRF and ARDS admitted to the intensive care unit undergoing mechanical ventilation. Each patient underwent an incremental/decremental PEEP trial that included five consecutive phases: PEEP 5 and 10 cmH2O, recruitment maneuver + PEEP 15 cmH2O, then PEEP 10 and 5 cmH2O again. We measured, at the end of each phase, recruitment from previous PEEP using the P-V curve method, and changes in DSS were continuously monitored by EIT.

Results

PEEP changes induced alveolar recruitment as assessed by the P-V curve method and changes in the amount of DSS (p < 0.001). Recruited volume measured by the P-V curves significantly correlated with the change in DSS (rs = 0.734, p < 0.001). Regional compliance of the dependent lung increased significantly with rising PEEP (median PEEP 5 cmH2O = 11.9 [IQR 10.4–16.7] ml/cmH2O, PEEP 15 cmH2O = 19.1 [14.2–21.3] ml/cmH2O; p < 0.001), whereas regional compliance of the nondependent lung decreased from PEEP 5 cmH2O to PEEP 15 cmH2O (PEEP 5 cmH2O = 25.3 [21.3–30.4] ml/cmH2O, PEEP 15 cmH2O = 20.0 [16.6–22.8] ml/cmH2O; p <0.001). By increasing the PEEP level, the center of ventilation moved toward the dependent lung, returning to the nondependent lung during the decremental PEEP steps.

Conclusions

The variation of DSSs dynamically measured by EIT correlates well with lung recruitment measured using the P-V curve technique. EIT might provide useful information to titrate personalized PEEP.

Trial registration

ClinicalTrials.gov, NCT02907840. Registered on 20 September 2016.
Appendix
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Metadata
Title
Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment
Authors
Savino Spadaro
Tommaso Mauri
Stephan H. Böhm
Gaetano Scaramuzzo
Cecilia Turrini
Andreas D. Waldmann
Riccardo Ragazzi
Antonio Pesenti
Carlo Alberto Volta
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1931-7

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