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Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography

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Abstract

Objective

To present a novel algorithm for estimating recruitable alveolar collapse and hyperdistension based on electrical impedance tomography (EIT) during a decremental positive end-expiratory pressure (PEEP) titration.

Design

Technical note with illustrative case reports.

Setting

Respiratory intensive care unit.

Patient

Patients with acute respiratory distress syndrome.

Interventions

Lung recruitment and PEEP titration maneuver.

Measurements and results

Simultaneous acquisition of EIT and X-ray computerized tomography (CT) data. We found good agreement (in terms of amount and spatial location) between the collapse estimated by EIT and CT for all levels of PEEP. The optimal PEEP values detected by EIT for patients 1 and 2 (keeping lung collapse <10%) were 19 and 17 cmH2O, respectively. Although pointing to the same non-dependent lung regions, EIT estimates of hyperdistension represent the functional deterioration of lung units, instead of their anatomical changes, and could not be compared directly with static CT estimates for hyperinflation.

Conclusions

We described an EIT-based method for estimating recruitable alveolar collapse at the bedside, pointing out its regional distribution. Additionally, we proposed a measure of lung hyperdistension based on regional lung mechanics.

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Acknowledgments

Financial support by grants from “Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)”, São Paulo State Research Support Foundation and “Financiadora de Estudos e Projetos (FINEP)”, Studies and Projects Financial Support Provider and to Dixtal Biomédica, Ltda.

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Authors and Affiliations

  1. Respiratory Intensive Care Unit, University of São Paulo School of Medicine, São Paulo, Brazil

    Eduardo L. V. Costa, João Batista Borges, Alexandre Melo, Carlos Toufen Jr, Stephan H. Bohm & Marcelo B. P. Amato

  2. Intensive Care Unit, Fundación Jiménez Días-Capio, Madrid, Spain

    Fernando Suarez-Sipmann

  3. Laboratório de Pneumologia LIM09, Faculdade de Medicina da USP, Av. Dr Arnaldo 455 (Sala 2206, 2nd floor), São Paulo, 01246-903, Brazil

    Marcelo B. P. Amato

Authors
  1. Eduardo L. V. Costa
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  2. João Batista Borges
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  3. Alexandre Melo
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  4. Fernando Suarez-Sipmann
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  5. Carlos Toufen Jr
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  6. Stephan H. Bohm
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  7. Marcelo B. P. Amato
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Corresponding author

Correspondence to Marcelo B. P. Amato.

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Costa, E.L.V., Borges, J.B., Melo, A. et al. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography. Intensive Care Med 35, 1132–1137 (2009). https://doi.org/10.1007/s00134-009-1447-y

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  • DOI: https://doi.org/10.1007/s00134-009-1447-y

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