Assessment of changes of regional ventilation distribution in the lung tissue depending on the driving pressure applied during high frequency jet ventilation
Szymon Bialka, Maja Copik, Katarzyna Rybczyk, Aleksander Owczarek, Ewa Jedrusik, Damian Czyzewski, Marek Filipowski, Eva Rivas, Kurt Ruetzler, Lukasz Szarpak, Hanna Misiolek, Szymon Bialka, Maja Copik, Katarzyna Rybczyk, Aleksander Owczarek, Ewa Jedrusik, Damian Czyzewski, Marek Filipowski, Eva Rivas, Kurt Ruetzler, Lukasz Szarpak, Hanna Misiolek
Abstract
Background: Electrical impedance tomography (EIT) is a tool to monitor regional ventilation distribution in patient's lungs under general anesthesia. The objective of this study was to assess the regional ventilation distribution using different driving pressures (DP) during high frequency jet ventilation (HFJV).
Methods: Prospective, observational, cross-over study. Patients undergoing rigid bronchoscopy were ventilated HFJV with DP 1.5 and 2.5 atm. Hemodynamic and ventilation parameters, as well as ventilation in different regions of the lungs in percentage of total ventilation, assessed by EIT, were recorded.
Results: Thirty-six patients scheduled for elective rigid bronchoscopy. The final analysis included thirty patients. There was no significant difference in systolic, diastolic and mean arterial blood pressure, heart rate, and peripheral saturation between the two groups. Peak inspiratory pressure, mean inspiratory pressure, tidal volume, and minute volume significantly increased in the second, compared to the first intervention group. Furthermore, there were no statistically significant differences between each time profiles in all ROI regions in EIT.
Conclusions: In our study intraoperative EIT was an effective method of functional monitoring of the lungs during HFJV for rigid bronchoscopy procedure. Lower driving pressure was as effective in providing sufficient ventilation distribution through the lungs as the higher driving pressure but characterized by lower airway pressure.
Trial registration: The study was registered on ClinicalTrials.gov under no. NCT02997072 .
Keywords: Driving pressure; High frequency; Inspiratory pressure; Jet ventilation.
Conflict of interest statement
Ethics approval and consent to participateThe study protocol has been approved by the Institutional Review Boards of the Medical University of Silesia, Katowice, Poland (identifier: KNW/0022/KB1/42/16), and written informed consent was obtained from the patients before their enrollment in the study.
Consent for publicationAll included patients or their family members signed the informed consent form to report individual patient data. All authors have confirmed the manuscript and approved the publication of the manuscript.
Competing interestsKurt Ruetzler, MD serves as an associate editor of BMC Anesthesiology, but was not involved in handling this manuscript in any manner. The authors declare that they have no competing interest.
Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Figures
![Fig. 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6069840/bin/12871_2018_552_Fig1_HTML.jpg)
![Fig. 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6069840/bin/12871_2018_552_Fig2_HTML.jpg)
![Fig. 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6069840/bin/12871_2018_552_Fig3_HTML.jpg)
![Fig. 4](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6069840/bin/12871_2018_552_Fig4_HTML.jpg)
References
- Fritzsche K, Osmers A. Anesthetic management in laryngotracheal surgery. High-frequency jet ventilation as strategy for ventilation during general anesthesia. Hno. 2011;59:931–941. doi: 10.1007/s00106-011-2369-x.
- Pathak V, Welsby I, Mahmood K, Wahidi M, MacIntyre N, Shofer S. Ventilation and anesthetic approaches for rigid bronchoscopy. Ann Am Thorac Soc. 2014;11:628–634. doi: 10.1513/AnnalsATS.201309-302FR.
- Ahuja S, Cohen B, Hinkelbein J, Diemunsch P, Ruetzler K. Practical anesthetic considerations in patients undergoing tracheobronchial surgeries: a clinical review of current literature. J Thorac Dis. 2016;8:3431–3441. doi: 10.21037/jtd.2016.11.57.
- Plotz FB, Slutsky AS, van Vught AJ, Heijnen CJ. Ventilator-induced lung injury and multiple system organ failure: a critical review of facts and hypotheses. Intensive Care Med. 2004;30:1865–1872. doi: 10.1007/s00134-004-2363-9.
- Kunst PW, Bohm SH, Vazquez de Anda G, Amato MB, Lachmann B, Postmus PE, de Vries PM. Regional pressure volume curves by electrical impedance tomography in a model of acute lung injury. Crit Care Med. 2000;28:178–183. doi: 10.1097/00003246-200001000-00029.
- Hickling KG. The pressure-volume curve is greatly modified by recruitment. A mathematical model of ARDS lungs. Am J Respir Crit Care Med. 1998;158:194–202. doi: 10.1164/ajrccm.158.1.9708049.
- Frerichs I, Amato MB, van Kaam AH, Tingay DG, Zhao Z, Grychtol B, Bodenstein M, Gagnon H, Bohm SH, Teschner E, Stenqvist O, Mauri T, Torsani V, Camporota L, Schibler A, Wolf GK, Gommers D, Leonhardt S, Adler A. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax. 2017;72:83–93. doi: 10.1136/thoraxjnl-2016-208357.
- Karsten J, Grusnick C, Paarmann H, Heringlake M, Heinze H. Positive end-expiratory pressure titration at bedside using electrical impedance tomography in post-operative cardiac surgery patients. Acta Anaesthesiol Scand. 2015;59:723–732. doi: 10.1111/aas.12518.
- Blankman P, Hasan D, Erik G, Gommers D. Detection of 'best' positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial. Crit Care. 2014;18:R95. doi: 10.1186/cc13866.
- Blankman P, Hasan D, van Mourik MS, Gommers D. Ventilation distribution measured with EIT at varying levels of pressure support and Neurally adjusted Ventilatory assist in patients with ALI. Intensive Care Med. 2013;39:1057–1062. doi: 10.1007/s00134-013-2898-8.
- Richard JC, Pouzot C, Gros A, Tourevieille C, Lebars D, Lavenne F, Frerichs I, Guerin C. Electrical impedance tomography compared to positron emission tomography for the measurement of regional lung ventilation: an experimental study. Crit Care. 2009;13:R82. doi: 10.1186/cc7900.
- Shi C, Boehme S, Bentley AH, Hartmann EK, Klein KU, Bodenstein M, Baumgardner JE, David M, Ullrich R, Markstaller K. Assessment of regional ventilation distribution: comparison of vibration response imaging (VRI) with electrical impedance tomography (EIT) PLoS One. 2014;9:e86638. doi: 10.1371/journal.pone.0086638.
- Hinz J, Moerer O, Neumann P, Dudykevych T, Hellige G, Quintel M. Effect of positive end-expiratory-pressure on regional ventilation in patients with acute lung injury evaluated by electrical impedance tomography. Eur J Anaesthesiol. 2005;22:817–825. doi: 10.1017/S0265021505001377.
- Spaeth J, Daume K, Goebel U, Wirth S, Schumann S. Increasing positive end-expiratory pressure (re-)improves intraoperative respiratory mechanics and lung ventilation after prone positioning. Br J Anaesth. 2016;116:838–846. doi: 10.1093/bja/aew115.
- He X, Jiang J, Liu Y, Xu H, Zhou S, Yang S, Shi X, Yuan H. Electrical impedance tomography-guided PEEP titration in patients undergoing laparoscopic abdominal surgery. Medicine (Baltimore) 2016;95:e3306. doi: 10.1097/MD.0000000000003306.
- Frerichs I, Hinz J, Herrmann P, Weisser G, Hahn G, Dudykevych T, Quintel M, Hellige G. Detection of local lung air content by electrical impedance tomography compared with electron beam CT. J Appl Physiol (1985) 2002;93:660–666. doi: 10.1152/japplphysiol.00081.2002.
- Hahn G, Sipinkova I, Baisch F, Hellige G. Changes in the thoracic impedance distribution under different ventilatory conditions. Physiol Meas. 1995;16:A161–A173. doi: 10.1088/0967-3334/16/3A/016.
- Hinz J, Neumann P, Dudykevych T, Andersson LG, Wrigge H, Burchardi H, Hedenstierna G. Regional ventilation by electrical impedance tomography: a comparison with ventilation scintigraphy in pigs. Chest. 2003;124:314–322. doi: 10.1378/chest.124.1.314.
- Kunst PW, Vonk Noordegraaf A, Hoekstra OS, Postmus PE, de Vries PM. Ventilation and perfusion imaging by electrical impedance tomography: a comparison with radionuclide scanning. Physiol Meas. 1998;19:481–490. doi: 10.1088/0967-3334/19/4/003.
- Spadaro S, Mauri T, Bohm SH, Scaramuzzo G, Turrini C, Waldmann AD, Ragazzi R, Pesenti A, Volta CA. Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment. Crit Care. 2018;22:26. doi: 10.1186/s13054-017-1931-7.
- Paula LF, Wellman TJ, Winkler T, Spieth PM, Guldner A, Venegas JG, Gama de Abreu M, Carvalho AR, Vidal Melo MF. Regional tidal lung strain in mechanically ventilated normal lungs. J Appl Physiol (1985) 2016;121:1335–1347. doi: 10.1152/japplphysiol.00861.2015.
- Gattinoni L, Caironi P. Prone positioning: beyond physiology. Anesthesiology. 2010;113:1262–1264. doi: 10.1097/ALN.0b013e3181fcd97e.
- Duggan M, Kavanagh BP. Pulmonary atelectasis: a pathogenic perioperative entity. Anesthesiology. 2005;102:838–854. doi: 10.1097/00000542-200504000-00021.
- Sutherasan Y, Vargas M, Pelosi P. Protective mechanical ventilation in the non-injured lung: review and meta-analysis. Crit Care. 2014;18:211. doi: 10.1186/cc13778.
- Protti A, Andreis DT, Monti M, Santini A, Sparacino CC, Langer T, Votta E, Gatti S, Lombardi L, Leopardi O, Masson S, Cressoni M, Gattinoni L. Lung stress and strain during mechanical ventilation: any difference between statics and dynamics? Crit Care Med. 2013;41:1046–1055. doi: 10.1097/CCM.0b013e31827417a6.
- Ladha K, Vidal Melo MF, McLean DJ, Wanderer JP, Grabitz SD, Kurth T, Eikermann M. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study. Bmj. 2015;351:h3646. doi: 10.1136/bmj.h3646.
- Neto AS, Hemmes SN, Barbas CS, Beiderlinden M, Fernandez-Bustamante A, Futier E, Gajic O, El-Tahan MR, Ghamdi AA, Gunay E, Jaber S, Kokulu S, Kozian A, Licker M, Lin WQ, Maslow AD, Memtsoudis SG, Reis Miranda D, Moine P, Ng T, Paparella D, Ranieri VM, Scavonetto F, Schilling T, Selmo G, Severgnini P, Sprung J, Sundar S, Talmor D, Treschan T, Unzueta C, Weingarten TN, Wolthuis EK, Wrigge H, Amato MB, Costa EL, de Abreu MG, Pelosi P, Schultz MJ. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med. 2016;4:272–280. doi: 10.1016/S2213-2600(16)00057-6.
Source: PubMed