NDLI: Positive end-expiratory pressure-induced changes in end-expiratory lung volume measured by spirometry and electric impedance tomography.

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Positive end-expiratory pressure-induced changes in end-expiratory lung volume measured by spirometry and electric impedance tomography.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Grivans, C. Lundin, S. Stenqvist, O. Lindgren, S.
Description	Country affiliation: Sweden Author Affiliation: Grivans C ( Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Sweden. christina.grivans@vgregion.se)
Abstract	BACKGROUND: A bedside tool for monitoring changes in end-expiratory lung volume (ΔEELV) would be helpful to set optimal positive end-expiratory pressure (PEEP) in acute lung injury/acute respiratory distress syndrome patients. The hypothesis of this study was that the cumulative difference of the inspiratory and expiratory tidal volumes of the first 10 breaths after a PEEP change accurately reflects the change in lung volume following a PEEP alteration. METHODS: Changing PEEP induces lung volume changes, which are reflected in differences between inspiratory and expiratory tidal volumes measured by spirometry. By adding these differences with correction for offset, for the first 10 breaths after PEEP change, cumulative tidal volume difference was calculated to estimate ΔEELV(VT) ((i-e)) . This method was evaluated in a lung model and in patients with acute respiratory failure during a PEEP trial. In patients, ΔEELV(VT) ((i-e)) were compared with simultaneously measured changes in lung impedance, by electric impedance tomography (EIT), using calibration vs. tidal volume to estimate changes in ΔEELV(EIT) . RESULTS: In the lung model, there was close correlation (R(2) = 0.99) between ΔEELV(VT) ((i-e)) and known lung model volume difference, with a bias of -4 ml and limits of agreement of 42 and -50 ml. In 12 patients, ΔEELV(EIT) was closely correlated to ΔEELV(VT) ((i-e)) (R(2) = 0.92), with mean bias of 50 ml and limits of agreement of 131 and -31 ml. Changes in EELV estimated by EIT (ΔEELV(EIT) ) exceeded measurements by spirometry (ΔEELV(VT) ((i-e)) ), with 15 (±15)%. CONCLUSIONS: We conclude that spirometric measurements of inspiratory-expiratory tidal volumes agree well with impedance changes monitored by EIT and can be used bedside to estimate PEEP-induced changes in EELV.
File Format	HTM / HTML
ISSN	00015172
Issue Number	9
Volume Number	55
e-ISSN	00015172
Journal	Acta Anaesthesiologica Scandinavica
Language	English
Publisher	Wiley
Publisher Date	2011-10-01
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Anesthesiology Electric Impedance Lung Volume Measurements Methods Positive-pressure Respiration Spirometry Tomography Aged Female Humans Male Middle Aged Respiratory Distress Syndrome, Adult Physiopathology Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine

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