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Electrical impedance tomography and trans-pulmonary pressure measurements in a patient with extreme respiratory drive

View Article: PubMed Central - PubMed

ABSTRACT

Preserving spontaneous breathing during mechanical ventilation prevents muscle atrophy of the diaphragm, but may lead to ventilator induced lung injury (VILI). We present a case in which monitoring of trans-pulmonary pressure and ventilation distribution using Electrical Impedance Tomography (EIT) provided essential information for preventing VILI.

No MeSH data available.


EIT ventilation distribution map before and after administration of rocuronium. The image represent a transverse plane at the level of the 5th intercostal space. Anatomical positioning is equal to CT imaging. Dark grey areas indicate no ventilation. White areas indicate high TIV, with decreasing TIV towards darker colors. (a) The fraction of regional TIV before administration of rocuronium was 25% and 75% in the non-dependent and the dependent regions, respectively. (b) After administration of rocuronium, global TIV decreased to 35% of that of before administration. The fraction of distribution of global TIV after rocuronium administration was 43% and 57% in the non-dependent and the dependent regions, respectively. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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fig3: EIT ventilation distribution map before and after administration of rocuronium. The image represent a transverse plane at the level of the 5th intercostal space. Anatomical positioning is equal to CT imaging. Dark grey areas indicate no ventilation. White areas indicate high TIV, with decreasing TIV towards darker colors. (a) The fraction of regional TIV before administration of rocuronium was 25% and 75% in the non-dependent and the dependent regions, respectively. (b) After administration of rocuronium, global TIV decreased to 35% of that of before administration. The fraction of distribution of global TIV after rocuronium administration was 43% and 57% in the non-dependent and the dependent regions, respectively. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Mentions: The patient was ventilated using pressure support ventilation with a PEEP of 18 cmH2O and a peak airway pressure of 28 cmH2O respectively. PaO2 and PaCO2 were both of 70 mmHg with 50% oxygen at that time. The tidal volume reached values up to 12 mL/kg ideal body weight due to strong inspiratory effort. Propofol and remifentanyl were increased from 240 to 400 mg/h and from 0.15 to 0.26 μg/kg/h respectively in an attempt to reduce tidal volume. Also, the ventilator mode was switched to volume-controlled mode with a tidal volume of 480 mL (6.4 mL/kg ideal body weight). The patient had persisting spontaneous efforts in a 1:2 ratio: one spontaneous effort during every second mandatory breath (Fig. 2A). An esophageal balloon catheter (NutriVent, Sidam S.R.L., Mirandola, Italy) was inserted and PTP was calculated. PTP was 34 cmH2O during inspiration and −9 cmH2O at end expiration (Fig. 2A). Simultaneously electrical impedance tomography (EIT) measurements were performed at the 5th intercostal space (Fig. 3).


Electrical impedance tomography and trans-pulmonary pressure measurements in a patient with extreme respiratory drive
EIT ventilation distribution map before and after administration of rocuronium. The image represent a transverse plane at the level of the 5th intercostal space. Anatomical positioning is equal to CT imaging. Dark grey areas indicate no ventilation. White areas indicate high TIV, with decreasing TIV towards darker colors. (a) The fraction of regional TIV before administration of rocuronium was 25% and 75% in the non-dependent and the dependent regions, respectively. (b) After administration of rocuronium, global TIV decreased to 35% of that of before administration. The fraction of distribution of global TIV after rocuronium administration was 43% and 57% in the non-dependent and the dependent regions, respectively. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

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Show All Figures
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fig3: EIT ventilation distribution map before and after administration of rocuronium. The image represent a transverse plane at the level of the 5th intercostal space. Anatomical positioning is equal to CT imaging. Dark grey areas indicate no ventilation. White areas indicate high TIV, with decreasing TIV towards darker colors. (a) The fraction of regional TIV before administration of rocuronium was 25% and 75% in the non-dependent and the dependent regions, respectively. (b) After administration of rocuronium, global TIV decreased to 35% of that of before administration. The fraction of distribution of global TIV after rocuronium administration was 43% and 57% in the non-dependent and the dependent regions, respectively. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Mentions: The patient was ventilated using pressure support ventilation with a PEEP of 18 cmH2O and a peak airway pressure of 28 cmH2O respectively. PaO2 and PaCO2 were both of 70 mmHg with 50% oxygen at that time. The tidal volume reached values up to 12 mL/kg ideal body weight due to strong inspiratory effort. Propofol and remifentanyl were increased from 240 to 400 mg/h and from 0.15 to 0.26 μg/kg/h respectively in an attempt to reduce tidal volume. Also, the ventilator mode was switched to volume-controlled mode with a tidal volume of 480 mL (6.4 mL/kg ideal body weight). The patient had persisting spontaneous efforts in a 1:2 ratio: one spontaneous effort during every second mandatory breath (Fig. 2A). An esophageal balloon catheter (NutriVent, Sidam S.R.L., Mirandola, Italy) was inserted and PTP was calculated. PTP was 34 cmH2O during inspiration and −9 cmH2O at end expiration (Fig. 2A). Simultaneously electrical impedance tomography (EIT) measurements were performed at the 5th intercostal space (Fig. 3).

View Article: PubMed Central - PubMed

ABSTRACT

Preserving spontaneous breathing during mechanical ventilation prevents muscle atrophy of the diaphragm, but may lead to ventilator induced lung injury (VILI). We present a case in which monitoring of trans-pulmonary pressure and ventilation distribution using Electrical Impedance Tomography (EIT) provided essential information for preventing VILI.

No MeSH data available.