Lung aeration and ventilation after percutaneous tracheotomy measured by electrical impedance tomography in non-hypoxemic critically ill patients: a prospective observational study

TY - JOUR

T1 - Lung aeration and ventilation after percutaneous tracheotomy measured by electrical impedance tomography in non-hypoxemic critically ill patients: a prospective observational study

AU - Eichler, Lars

AU - Mueller, Jakob

AU - Grensemann, Jörn

AU - Frerichs, Inez

AU - Zöllner, Christian

AU - Kluge, Stefan

PY - 2018/11/15

Y1 - 2018/11/15

N2 - BACKGROUND: Percutaneous dilatational tracheotomy (PDT) may lead to transient impairment of pulmonary function due to suboptimal ventilation, loss of positive end-expiratory pressure (PEEP) and repetitive suction maneuvers during the procedure. Possible changes in regional lung aeration were investigated using electrical impedance tomography (EIT), an increasingly implied instrument for bedside monitoring of pulmonary aeration.METHODS: With local ethics committee approval, after obtaining written informed consent 29 patients scheduled for elective PDT under bronchoscopic control were studied during mechanical ventilation in supine position. Anesthetized patients were monitored with a 16-electrode EIT monitor for 2 min at four time points: (a) before and (b) after initiation of neuromuscular blockade (NMB), (c) after dilatational tracheostomy (PDT) and (d) after a standardized recruitment maneuver (RM) following surgery, respectively. Possible changes in lung aeration were detected by changes in end-expiratory lung impedance (Δ EELI). Global and regional ventilation was characterized by analysis of tidal impedance variation.RESULTS: While NMB had no detectable effect on EELI, PDT led to significantly reduced EELI in dorsal lung regions as compared to baseline, suggesting reduced regional aeration. This effect could be reversed by a standardized RM. Mean delta EELI from baseline (SE) was: NMB - 47 ± 62; PDT - 490 ± 180; RM - 89 ± 176, values shown as arbitrary units (a.u.). Analysis of regional tidal impedance variation, a robust measure of regional ventilation, did not show significant changes in ventilation distribution.CONCLUSION: Though changes of EELI might suggest temporary loss of aeration in dorsal lung regions, PDT does not lead to significant changes in either regional ventilation distribution or oxygenation.

AB - BACKGROUND: Percutaneous dilatational tracheotomy (PDT) may lead to transient impairment of pulmonary function due to suboptimal ventilation, loss of positive end-expiratory pressure (PEEP) and repetitive suction maneuvers during the procedure. Possible changes in regional lung aeration were investigated using electrical impedance tomography (EIT), an increasingly implied instrument for bedside monitoring of pulmonary aeration.METHODS: With local ethics committee approval, after obtaining written informed consent 29 patients scheduled for elective PDT under bronchoscopic control were studied during mechanical ventilation in supine position. Anesthetized patients were monitored with a 16-electrode EIT monitor for 2 min at four time points: (a) before and (b) after initiation of neuromuscular blockade (NMB), (c) after dilatational tracheostomy (PDT) and (d) after a standardized recruitment maneuver (RM) following surgery, respectively. Possible changes in lung aeration were detected by changes in end-expiratory lung impedance (Δ EELI). Global and regional ventilation was characterized by analysis of tidal impedance variation.RESULTS: While NMB had no detectable effect on EELI, PDT led to significantly reduced EELI in dorsal lung regions as compared to baseline, suggesting reduced regional aeration. This effect could be reversed by a standardized RM. Mean delta EELI from baseline (SE) was: NMB - 47 ± 62; PDT - 490 ± 180; RM - 89 ± 176, values shown as arbitrary units (a.u.). Analysis of regional tidal impedance variation, a robust measure of regional ventilation, did not show significant changes in ventilation distribution.CONCLUSION: Though changes of EELI might suggest temporary loss of aeration in dorsal lung regions, PDT does not lead to significant changes in either regional ventilation distribution or oxygenation.

KW - Journal Article

U2 - 10.1186/s13613-018-0454-y

DO - 10.1186/s13613-018-0454-y

M3 - SCORING: Journal article

C2 - 30443867

VL - 8

SP - 110

JO - ANN INTENSIVE CARE

JF - ANN INTENSIVE CARE

SN - 2110-5820

IS - 1

ER -