Acute respiratory syndrome distress (ARDS) is a clinical common syndrome with high mortality. Mechanical ventilation (MV) is the cornerstone of management of ARDS but can lead to ventilator-induced lung injury. Positive end-expiratory pressure (PEEP), as one of main component of MV, has been widely used in the clinical practice. However, how to best set PEEP is still a difficult problem for moderate to severe ARDS patients. EIT, an imaging tool evaluating the regional ventilation distribution at the bedside, can achieve the individual PEEP selection for all mechanically ventilated patients. This article compared the effect of PEEP titrated guided by EIT with fraction of inspired oxygen (FiO2)-PEEP table on the ventilation-perfusion mismatch.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
69
Electric impedance tomography-guided PEEP titration
Zhongda Hospital, School of Medicine, Southeast University
Nanjing, Jiangsu, China
Difference in ventilation-perfusion mismatch between EIT-PEEP, low-PEEP, and high PEEP
EIT-PEEP was obtained by EIT, low-PEEP was obtained by low FIO2-PEEP table, and high-PEEP was obtained by high FIO2-PEEP table.
Time frame: up to 24 hours
difference in center of ventilation (COV) between EIT-PEEP, low-PEEP, and high PEEP
COV was obtained by EIT monitoring
Time frame: up to 24 hours
Difference in dead space measured with EIT between EIT-PEEP, low-PEEP, and high PEEP
dead space was obtained by EIT monitoring
Time frame: up to 24 hours
Difference in shunt measured with EIT between EIT-PEEP, low-PEEP, and high PEEP
shunt was obtained by EIT monitoring
Time frame: up to 24 hours
Difference in wasted ventilation measured with EIT between EIT-PEEP, low-PEEP, and high PEEP
wasted ventilation was obtained by EIT monitoring
Time frame: up to 24 hours
Difference in wasted perfusion measured with EIT between EIT-PEEP, low-PEEP, and high PEEP
wasted perfusion was obtained by EIT monitoring
Time frame: up to 24 hours
ventilation distribution measured with EIT between EIT-PEEP, low-PEEP, and high PEEP
ventilation distribution was obtained by EIT in difference regions
Time frame: up to 24 hours
perfusion distribution measured with EIT between EIT-PEEP, low-PEEP, and high PEEP
perfusion distribution was obtained by EIT in difference regions
Time frame: up to 24 hours
Correlations between ventilation-perfusion mismatch and overdistension and lung collapses
Overdistension (%) and lung collapses (%) will be assessed by EIT. These two values cannot be measured separately. V/Q mismatch will be computed by EIT, and expressed in %. Correlation will be performed by linear regression.
Time frame: up to 24 hours
recruitment-to-inflation (R/I) ratio
recruitment-to-inflation (R/I) ratio was computed between the two PEEP levels
Time frame: up to 24 hours
PaO2/FIO2
PaO2/FIO2 was obtained by gas analysis
Time frame: up to 24 hours
respiratory system mechanics
respiratory system compliance included lung compliance, chest wall compliance, and respiratory system compliance. respiratory system resistance will be computed as the inverse of compliance.
Time frame: up to 24 hours
Correlation between V/Q mismatch markers and recruitability
Recruitability will be assessed between 15 and 5 cmH2O by respiratory mechanics, as the recruited volumes value (in mL). R/I ratio will be derived from these data (no unit). V/Q mismatch will be computed by EIT, and expressed in %. Correlation will be performed by linear regression.
Time frame: up to 24 hours
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