1. Assessment of electrical impedance tomography to set optimal positive end-expiratory pressure for veno-venous ECMO-treated severe ARDS patients
- Author
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Fanny Vardon-Bounes, Thierry Seguin, Vincent Minville, Christelle Soulé, Jean-Marie Conil, Stéphanie Ruiz, Bernard Georges, Olivier Fourcade, Floriane Puel, and Laure Crognier
- Subjects
Male ,ARDS ,medicine.medical_specialty ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,Positive-Pressure Respiration ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Internal medicine ,Electric Impedance ,Tidal Volume ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Prospective Studies ,Respiratory system ,Lung ,Electrical impedance tomography ,Positive end-expiratory pressure ,Monitoring, Physiologic ,Mechanical ventilation ,Respiratory Distress Syndrome ,business.industry ,030208 emergency & critical care medicine ,Middle Aged ,respiratory system ,medicine.disease ,respiratory tract diseases ,Intensive Care Units ,medicine.anatomical_structure ,030228 respiratory system ,Breathing ,Cardiology ,Female ,France ,Tomography, X-Ray Computed ,business ,therapeutics ,circulatory and respiratory physiology - Abstract
Purpose Ultra-protective ventilation with low tidal volume is used in severe acute respiratory distress syndrome (ARDS) patients under extracorporeal membrane oxygenation (ECMO). However, the optimal positive end-expiratory pressure (PEEP) is unknown. The aim of our study was to assess electrical impedance tomography's (EIT) ability to choose the best PEEP for these patients. Materials and methods A recruitment maneuver and after a decremental PEEP trial from 20 to 5 cmH20 were monitored by EIT, with lung images divided into four ventral-to-dorsal horizontal regions of interest. For each patient, three EIT-based PEEP were defined: PEEP ODCLmin (lowest pressure with the least EIT-based collapse lung [CL] and overdistension [OD]), PEEP ODCL15 (lowest pressure able to limit EIT-based collapse to less than or equal to 15% with the least overdistension) and PEEP Comp (PEEP with the highest EIT-based compliance). Results High PEEP levels were significantly associated with more overdistension while decreasing PEEP led to more collapsed zones. PEEP ODCL15 and PEEP Comp were in complete agreement with the reference Pulmonary PEEP (chosen according to usual respiratory clinical and ultrasound criteria), PEEP ODCLmin was in average agreement with the Pulmonary PEEP. Conclusion EIT may be a useful real-time monitoring technique to optimize the PEEP level in severe ARDS patients under ECMO. Take-home message Ultra-protective ventilation with low tidal volume is used in severe acute respiratory distress syndrome patients under extracorporeal membrane oxygenation (ECMO), but the optimal positive end-expiratory pressure is unknown. This trial shows that electrical impedance tomography may be an interesting non-invasive bedside tool to provide real-time monitoring of PEEP impact in severe ARDS patients under ECMO. The Pulmovista® electrical impedance tomography was provided by Drager (Lubeck, Germany) during the study period. Drager had no role in the study design, collection, analysis and interpretation of the data, writing the article, or the decision to submit the article for publication.
- Published
- 2020