Determination of respiratory gas flow by electrical impedance tomography in an animal model of mechanical ventilation

Abstract

Background: A recent method determines regional gas flow of the lung by electrical impedance tomography (EIT). The aim of this study is to show the applicability of this method in a porcine model of mechanical ventilation in healthy and diseased lungs. Our primary hypothesis is that global gas flow measured by EIT can be correlated with spirometry. Our secondary hypothesis is that regional analysis of respiratory gas flow delivers physiologically meaningful results.

Methods: In two sets of experiments n = 7 healthy pigs and n = 6 pigs before and after induction of lavage lung injury were investigated. EIT of the lung and spirometry were registered synchronously during ongoing mechanical ventilation. In-vivo aeration of the lung was analysed in four regions-of-interest (ROI) by EIT: 1) global, 2) ventral (non-dependent), 3) middle and 4) dorsal (dependent) ROI. Respiratory gas flow was calculated by the first derivative of the regional aeration curve. Four phases of the respiratory cycle were discriminated. They delivered peak and late inspiratory and expiratory gas flow (PIF, LIF, PEF, LEF) characterizing early or late inspiration or expiration.

Results: Linear regression analysis of EIT and spirometry in healthy pigs revealed a very good correlation measuring peak flow and a good correlation detecting late flow. PIFEIT = 0.702 · PIFspiro + 117.4, r(2) = 0.809; PEFEIT = 0.690 · PEFspiro-124.2, r(2) = 0.760; LIFEIT = 0.909 · LIFspiro + 27.32, r(2) = 0.572 and LEFEIT = 0.858 · LEFspiro-10.94, r(2) = 0.647. EIT derived absolute gas flow was generally smaller than data from spirometry. Regional gas flow was distributed heterogeneously during different phases of the respiratory cycle. But, the regional distribution of gas flow stayed stable during different ventilator settings. Moderate lung injury changed the regional pattern of gas flow.

Conclusions: We conclude that the presented method is able to determine global respiratory gas flow of the lung in different phases of the respiratory cycle. Additionally, it delivers meaningful insight into regional pulmonary characteristics, i.e. the regional ability of the lung to take up and to release air.

Figures

Figure 1

Determination of gas flow during different parts of the respiratory cycle in an example of EIT data measured during pressure controlled ventilation in the global region-of-interest. Blue line: measured and calibrated EIT signal, VEIT(t) is gas content over time. Red line: calculated flow signal from EIT data, V’EIT(t) is gas flow over time. Late inspiratory and expiratory flow (PIF, LIF, PEF and LEF) are derived from gas flow data.

Figure 2

Example of gas flow measured by spirometry. FLOWspiro(t). Peak and late inspiratory and expiratory flow (PIF, LIF, PEF and LEF) are used to validate the respective parameters as determined by EIT.

Figure 3

Linear regression analysis and correlation of gas flow measured by EIT and spirometry. Dotted line: y = x + 0, black line: linear regression. a (left, top). Peak inspiratory flow (PIF). b (left, bottom). Late inspiratory flow (LIF). c (right, top). Peak expiratory flow (PEF). d (right, bottom). Late expiratory flow (LEF).

Figure 4

Bland-Altman plot of gas flow measured by EIT and spirometry. a (left, top). Peak inspiratory flow (PIF). b (left, bottom). Late inspiratory flow (LIF). c (right, top). Peak expiratory flow (PEF). d (right, bottom). Late expiratory flow (LEF).

Figure 5

Pattern of regional gas flow (analysis of global, ventral, middle and dorsal region-of-interest) in n = 7 pigs during pressure controlled ventilation with different ventilator settings. PEEP = positive end-expiratory pressure. VT = tidal volume. Black arrow: significant group difference. Grey crossed arrow: no significant group difference. a (left, top). Peak inspiratory flow (PIF). b (left, bottom). Late inspiratory flow (LIF). c (right, top). Peak expiratory flow (PEF). d (right, bottom). Late expiratory flow (LEF).

Figure 6

Pattern of regional gas flow (analysis of global, ventral, middle and dorsal region-of-interest) in n = 6 pigs during pressure controlled ventilation in healthy condition (BL = baseline) and after lung injury induced by lavage (LAV = lavage). Black arrow: significant difference. Grey crossed arrow: no significant difference. a (left, top). Peak inspiratory flow (PIF). b (left, bottom). Late inspiratory flow (LIF). c (right, top). Peak expiratory flow (PEF). d (right, bottom). Late expiratory flow (LEF).