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Báo cáo y học: "PEEP titration guided by ventilation homogeneity: a feasibility study using electrical impedance tomography"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: PEEP titration guided by ventilation homogeneity: a feasibility study using electrical impedance tomography. | Zhao et al. Critical Care 2010 14 R8 http ccforum.eom content 14 1 R8 c CRITICAL CARE RESEARCH Open Access PEEP titration guided by ventilation homogeneity a feasibility study using electrical impedance tomography Zhanqi Zhao 1 2 Daniel Steinmann2 Inez Frerichs3 Josef Guttmann2 and Knut Moller1 Abstract Introduction Lung protective ventilation requires low tidal volume and suitable positive end-expiratory pressure PEEP . To date few methods have been accepted for clinical use to set the appropriate PEEP The aim of this study was to test the feasibility of PEEP titration guided by ventilation homogeneity using the global inhomogeneity GI index based on electrical impedance tomography EIT images. Methods In a retrospective study 10 anesthetized patients with healthy lungs mechanically ventilated under volume-controlled mode were investigated. Ventilation distribution was monitored by EIT. A standardized incremental PEEP trial PEEP from 0 to 28 mbar 2 mbar per step was conducted. During the PEEP trial optimal PEEP level for each patient was determined when the air was most homogeneously distributed in the lung indicated by the lowest GI index value. Two published methods for setting PEEP were included for comparison based on the maximum global dynamic compliance and the intra-tidal compliance-volume curve. Results No significant differences in the results were observed between the GI index method 12.2 4.6 mbar and the dynamic compliance method 11.4 2.3 mbar P 0.6 or between the GI index and the compliance-volume curve method 12.2 4.9 mbar P 0.6 . Conclusions According to the results it is feasible and reasonable to use the GI index to select the PEEP level with respect to ventilation homogeneity. The GI index may provide new insights into the relationship between lung mechanics and tidal volume distribution and may be used to guide ventilator settings. Introduction Under the condition of general anesthesia during mechanical ventilation patients are sedated and the .