Application of electrical impedance tomography on positive end-expiratory pressure setting in patients with acute respiratory distress syndrome_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SHEN Jilong , WANG Chen , WANG Yuanyuan , DENG Yanjun , ZHOU Qingtai , XU Duo , WANG Suchun , CHEN Yali ,  WANG Mingdeng

Intensive Care Unit, Suzhou Science&Technology Hospital, Suzhou, Jiangsu 215153, P. R. China;

Corresponding?author：

WANG Mingdeng, Email: 1376590818@qq.com

Keywords：

Acute respiratory distress syndrome; positive end-expiratory pressure; ultrasonography; electrical impedance tomography

DOI：

10.7507/1671-6205.202211004

Video：

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Objective To explore the clinical application value of electrical impedance tomography (EIT) individualized adjustment of positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS). Methods The ARDS patients requiring mechanical ventilation who admitted between April 2019 and March 2022 were recruited in the study. They were randomly divided into 3 groups with 12 cases in each group. Optimal PEEP was set using ARDSnet method (a control group), lung ultrasound scoring method (LUS group) and EIT adjustment method (EIT group). The changes of hemodynamics, blood gas analysis, respiratory mechanics, extravascular lung water index and other indicators of the patients were recorded at each time point. Results There was no significant difference in PEEP between the EIT group and the LUS group, but PEEP in both the EIT group and the LUS group was significantly higher than the control group (P<0.05). After 12 hours of treatment, the dynamic lung compliance of the control group did not change significantly, while the dynamic lung compliance ventilation of the LUS group and the EIT group was significantly improved for 12 hours, and the improvement in the EIT group was significantly better than that in the control group (P<0.05). After treatment, the oxygenation index in the three groups was significantly increased, and the oxygenation index in the EIT group was significantly higher than that in the control group (P<0.05). There was no significant difference in hemodynamics between the three groups before and after treatment (P>0.05). The extravascular lung water index of the three groups after treatment was significantly decreased, and the LUS group and the EIT group decreased more significantly than the control group (P<0.05). Conclusion In the PEEP setting of ARDS patients, the use of EIT personalized adjustment method can effectively improve the patient’s lung compliance and oxygenation index, and reduce extravascular lung water, without affecting hemodynamics.

Citation： SHEN Jilong, WANG Chen, WANG Yuanyuan, DENG Yanjun, ZHOU Qingtai, XU Duo, WANG Suchun, CHEN Yali, WANG Mingdeng. Application of electrical impedance tomography on positive end-expiratory pressure setting in patients with acute respiratory distress syndrome. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(1): 32-37. doi: 10.7507/1671-6205.202211004 Copy

1.	Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA, 2016, 315(8): 788-800.
2.	王橋生, 王美求, 符暉. 膿毒癥相關急性呼吸窘迫綜合征短期死亡風險評分標準構建. 中國呼吸與危重監護雜志, 2022, 21(3): 162-169.
3.	Sahetya SK, Goligher EC, Brower RG. Fifty years of research in ARDS. Setting positive end-expiratory pressure in acute respiratory distress syndrome. Am J Respir Crit Care Med, 2017, 195(11): 1429-1438.
4.	Adler A, Amato MB, Arnold JH, et al. Whither lung EIT: where are we, where do we want to go and what do we need to get there?. Physiol Meas, 2012, 33(5): 679-694.
5.	Caironi P, Cressoni M, Chiumello D, et al. Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med, 2010, 181(6): 578-586.
6.	中國衛生信息與健康醫療大數據學會重癥醫學分會標準委員會, 北京腫瘤學會重癥醫學專業委員會, 中國重癥肺電阻抗工作組. 肺電阻抗成像技術在重癥呼吸管理中的臨床應用中國專家共識. 中華醫學雜志, 2022, 2(9): 615-628.
7.	The ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
8.	The Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-1308.
9.	李蓮花, 楊倩, 李黎明, 等. 肺部超聲評分評估急性呼吸窘迫綜合征患者病情嚴重程度及預后的價值. 中華危重病急救醫學, 2015, 27(7): 579-584.
10.	Bouhemad B, Brisson H, Le-Guen M, et al. Bedside ultrasound assessment of positive end-xpiratory pressure-induced lung recruitment. Am J Respir Crit Care Med, 2011, 183(3): 341-347.
11.	張斌, 吳秀, 曹薇, 等. 肺部超聲評分在呼吸重癥疾病中的應用. 中國呼吸與危重監護雜志, 2019, 18(1): 93-97.
12.	Bouhemad B, Liu ZH, Arbelot C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med, 2010, 38(1): 84-92.
13.	Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet, 1967, 290(7511): 319-323.
14.	郭俊, 徐景龍. PEEP水平選擇對俯臥位通氣重度ARDS患者肺復張效果和炎性因子的影響. 中華危重病急救醫學, 2020, 32(6): 702-706.
15.	陳宇, 羅春梅, 賀斌峰, 等. 不同水平PEEP治療對ICU非ALI/ARDS患者ARDS發生率影響的Meta分析. 中華危重病急救醫學, 2020, 32(2): 155-160.
16.	王金龍, 黃英姿. 驅動壓在急性呼吸窘迫綜合征肺保護性通氣中的研究進展. 中華內科雜志, 2018, 57(10): 766-768.
17.	Lachmann B. Open up the lung and keep the lung open. Intensive Care Med, 1992, 18(6): 319-321.
18.	Kalchiem-Dekel O, Shanholtz CB, Jeudy J, et al. Feasibility, safety, and utility of bronchoscopy in patients with ARDS while in the prone position. Crit Care, 2018, 22(1): 54.
19.	Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med, 2013, 369(22): 2126-2136.
20.	王麗, 宋寧寧, 劉云, 等. 振動反應成像技術在ARDS患者PEEP設置中的應用. 國際呼吸雜志, 2019, 39(3): 210-214.
21.	Zhao ZQ, Chang MY, Chang MY, et al. Positive end-expiratory pressure titration with electrical impedance tomography and pressure-volume curve in severe acute respiratory distress syndrome. Ann Intensive Care, 2019, 9(1): 7.
22.	Sella N, Zarantonello F, Andreatta G, et al. Positive end-expiratory pressure titration in COVID-19 acute respiratory failure: electrical impedance tomography vs. PEEP/FiO₂ tables. Crit Care, 2020, 24(1): 540.
23.	van der Zee P, Somhorst P, Endeman H, et al. Electrical impedance tomography for positive end-expiratory pressure titration in COVID-19-related acute respiratory distress syndrome. Am J Respir Crit Care Med, 2020, 202(2): 280-284.
24.	He HW, Chi Y, Yang YY, et al. Early individualized positive end-expiratory pressure guided by electrical impedance tomography in acute respiratory distress syndrome: a randomized controlled clinical trial. Crit Care, 2021, 25(1): 230.
25.	Hsu HJ, Chang HT, Zhao ZQ, et al. Positive end-expiratory pressure titration with electrical impedance tomography and pressure-volume curve: a randomized trial in moderate to severe ARDS. Physiol Meas, 2021, 42(1): 014002.
26.	汪曉強, 吳彤, 田婕. 超聲診斷肺部疾病在重癥醫學中的應用. 醫學綜述, 2018, 24(23): 161-165.
27.	Ma H, Huang DZ, Zhang MZ, et al. Lung ultrasound is a reliable method for evaluating extravascular lung water volume in rodents. BMC Anesthesiol, 2015, 15(1): 162.
28.	羅前程, 劉瑞, 曲凱麗, 等. 床旁即時肺部超聲結合壓力–容積曲線設定PEEP對ARDS肺復張的臨床評價. 寧夏醫科大學學報, 2021, 43(1): 22-28.
29.	田翠杰, 王海播, 張文平, 等. 電阻抗斷層成像技術在呼吸系統疾病中的臨床應用. 中國呼吸與危重監護雜志, 2020, 19(6): 617-620.
30.	Perier F, Tuffet S, Maraffi T, et al. Electrical impedance tomography to titrate positive end-expiratory pressure in COVID-19 acute respiratory distress syndrome. Crit Care, 2020, 24(1): 678.
31.	Puel F, Crognier L, Soulé C, et al. Assessment of electrical impedance tomography to set optimal positive end-expiratory pressure for veno-venous ECMO-treated severe ARDS patients. J Crit Care, 2020, 60: 38-44.
32.	Becher T, Buchholz V, Hassel D, et al. Individualization of PEEP and tidal volume in ARDS patients with electrical impedance tomography: a pilot feasibility study. Ann Intensive Care, 2021, 11(1): 89.
33.	Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome: advances in diagnosis and treatment. JAMA, 2018, 319(7): 698-710.

1. Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA, 2016, 315(8): 788-800.
2. 王橋生, 王美求, 符暉. 膿毒癥相關急性呼吸窘迫綜合征短期死亡風險評分標準構建. 中國呼吸與危重監護雜志, 2022, 21(3): 162-169.
3. Sahetya SK, Goligher EC, Brower RG. Fifty years of research in ARDS. Setting positive end-expiratory pressure in acute respiratory distress syndrome. Am J Respir Crit Care Med, 2017, 195(11): 1429-1438.
4. Adler A, Amato MB, Arnold JH, et al. Whither lung EIT: where are we, where do we want to go and what do we need to get there?. Physiol Meas, 2012, 33(5): 679-694.
5. Caironi P, Cressoni M, Chiumello D, et al. Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med, 2010, 181(6): 578-586.
6. 中國衛生信息與健康醫療大數據學會重癥醫學分會標準委員會, 北京腫瘤學會重癥醫學專業委員會, 中國重癥肺電阻抗工作組. 肺電阻抗成像技術在重癥呼吸管理中的臨床應用中國專家共識. 中華醫學雜志, 2022, 2(9): 615-628.
7. The ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
8. The Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-1308.
9. 李蓮花, 楊倩, 李黎明, 等. 肺部超聲評分評估急性呼吸窘迫綜合征患者病情嚴重程度及預后的價值. 中華危重病急救醫學, 2015, 27(7): 579-584.
10. Bouhemad B, Brisson H, Le-Guen M, et al. Bedside ultrasound assessment of positive end-xpiratory pressure-induced lung recruitment. Am J Respir Crit Care Med, 2011, 183(3): 341-347.
11. 張斌, 吳秀, 曹薇, 等. 肺部超聲評分在呼吸重癥疾病中的應用. 中國呼吸與危重監護雜志, 2019, 18(1): 93-97.
12. Bouhemad B, Liu ZH, Arbelot C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med, 2010, 38(1): 84-92.
13. Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet, 1967, 290(7511): 319-323.
14. 郭俊, 徐景龍. PEEP水平選擇對俯臥位通氣重度ARDS患者肺復張效果和炎性因子的影響. 中華危重病急救醫學, 2020, 32(6): 702-706.
15. 陳宇, 羅春梅, 賀斌峰, 等. 不同水平PEEP治療對ICU非ALI/ARDS患者ARDS發生率影響的Meta分析. 中華危重病急救醫學, 2020, 32(2): 155-160.
16. 王金龍, 黃英姿. 驅動壓在急性呼吸窘迫綜合征肺保護性通氣中的研究進展. 中華內科雜志, 2018, 57(10): 766-768.
17. Lachmann B. Open up the lung and keep the lung open. Intensive Care Med, 1992, 18(6): 319-321.
18. Kalchiem-Dekel O, Shanholtz CB, Jeudy J, et al. Feasibility, safety, and utility of bronchoscopy in patients with ARDS while in the prone position. Crit Care, 2018, 22(1): 54.
19. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med, 2013, 369(22): 2126-2136.
20. 王麗, 宋寧寧, 劉云, 等. 振動反應成像技術在ARDS患者PEEP設置中的應用. 國際呼吸雜志, 2019, 39(3): 210-214.
21. Zhao ZQ, Chang MY, Chang MY, et al. Positive end-expiratory pressure titration with electrical impedance tomography and pressure-volume curve in severe acute respiratory distress syndrome. Ann Intensive Care, 2019, 9(1): 7.
22. Sella N, Zarantonello F, Andreatta G, et al. Positive end-expiratory pressure titration in COVID-19 acute respiratory failure: electrical impedance tomography vs. PEEP/FiO₂ tables. Crit Care, 2020, 24(1): 540.
23. van der Zee P, Somhorst P, Endeman H, et al. Electrical impedance tomography for positive end-expiratory pressure titration in COVID-19-related acute respiratory distress syndrome. Am J Respir Crit Care Med, 2020, 202(2): 280-284.
24. He HW, Chi Y, Yang YY, et al. Early individualized positive end-expiratory pressure guided by electrical impedance tomography in acute respiratory distress syndrome: a randomized controlled clinical trial. Crit Care, 2021, 25(1): 230.
25. Hsu HJ, Chang HT, Zhao ZQ, et al. Positive end-expiratory pressure titration with electrical impedance tomography and pressure-volume curve: a randomized trial in moderate to severe ARDS. Physiol Meas, 2021, 42(1): 014002.
26. 汪曉強, 吳彤, 田婕. 超聲診斷肺部疾病在重癥醫學中的應用. 醫學綜述, 2018, 24(23): 161-165.
27. Ma H, Huang DZ, Zhang MZ, et al. Lung ultrasound is a reliable method for evaluating extravascular lung water volume in rodents. BMC Anesthesiol, 2015, 15(1): 162.
28. 羅前程, 劉瑞, 曲凱麗, 等. 床旁即時肺部超聲結合壓力–容積曲線設定PEEP對ARDS肺復張的臨床評價. 寧夏醫科大學學報, 2021, 43(1): 22-28.
29. 田翠杰, 王海播, 張文平, 等. 電阻抗斷層成像技術在呼吸系統疾病中的臨床應用. 中國呼吸與危重監護雜志, 2020, 19(6): 617-620.
30. Perier F, Tuffet S, Maraffi T, et al. Electrical impedance tomography to titrate positive end-expiratory pressure in COVID-19 acute respiratory distress syndrome. Crit Care, 2020, 24(1): 678.
31. Puel F, Crognier L, Soulé C, et al. Assessment of electrical impedance tomography to set optimal positive end-expiratory pressure for veno-venous ECMO-treated severe ARDS patients. J Crit Care, 2020, 60: 38-44.
32. Becher T, Buchholz V, Hassel D, et al. Individualization of PEEP and tidal volume in ARDS patients with electrical impedance tomography: a pilot feasibility study. Ann Intensive Care, 2021, 11(1): 89.
33. Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome: advances in diagnosis and treatment. JAMA, 2018, 319(7): 698-710.

Chinese Journal of Respiratory and Critical Care Medicine

Application of electrical impedance tomography on positive end-expiratory pressure setting in patients with acute respiratory distress syndrome

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