Dataset Information

The use of electrical impedance tomography for individualized ventilation strategy in COVID-19: a case report.

ABSTRACT:

Background

Clinical management of COVID-19 requires close monitoring of lung function. While computed tomography (CT) offers ideal way to identify the phenotypes, it cannot monitor the patient response to therapeutic interventions. We present a case of ventilation management for a COVID-19 patient where electrical impedance tomography (EIT) was used to personalize care.

Case presentation

The patient developed acute respiratory distress syndrome, required invasive mechanical ventilation, and was subsequently weaned. EIT was used multiple times: to titrate the positive end-expiratory pressure, understand the influence of body position, and guide the support levels during weaning and after extubation. We show how EIT provides bedside monitoring of the patient´s response to various therapeutic interventions and helps guide treatments.

Conclusion

EIT provides unique information that may help the ventilation management in the pandemic of COVID-19.

SUBMITTER: Zhao Z

PROVIDER: S-EPMC7820832 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

The use of electrical impedance tomography for individualized ventilation strategy in COVID-19: a case report.

Zhao Zhanqi Z Zhang Jin-Shou JS Chen Ying-Tzu YT Chang Hou-Tai HT Hsu Yeong-Long YL Frerichs Inéz I Adler Andy A

BMC pulmonary medicine 20210122 1

<h4>Background</h4>Clinical management of COVID-19 requires close monitoring of lung function. While computed tomography (CT) offers ideal way to identify the phenotypes, it cannot monitor the patient response to therapeutic interventions. We present a case of ventilation management for a COVID-19 patient where electrical impedance tomography (EIT) was used to personalize care.<h4>Case presentation</h4>The patient developed acute respiratory distress syndrome, required invasive mechanical ventil ...[more]

PMID: 33482796

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Project description:ObjectivesTo provide proof-of-concept for a protocol applying a strategy of personalized mechanical ventilation in children with acute respiratory distress syndrome. Positive end-expiratory pressure and inspiratory pressure settings were optimized using real-time electrical impedance tomography aiming to maximize lung recruitment while minimizing lung overdistension.DesignProspective interventional trial.SettingTwo PICUs.PatientsEight children with early acute respiratory distress syndrome (< 72 hr).InterventionsOn 3 consecutive days, electrical impedance tomography-guided positive end-expiratory pressure titration was performed by using regional compliance analysis. The Acute Respiratory Distress Network high/low positive end-expiratory pressure tables were used as patient's safety guardrails. Driving pressure was maintained constant. Algorithm includes the following: 1) recruitment of atelectasis: increasing positive end-expiratory pressure in steps of 4 mbar; 2) reduction of overdistension: decreasing positive end-expiratory pressure in steps of 2 mbar until electrical impedance tomography shows collapse; and 3) maintaining current positive end-expiratory pressure and check regional compliance every hour. In case of derecruitment start at step 1.Measurements and main resultsLung areas classified by electrical impedance tomography as collapsed or overdistended were changed on average by -9.1% (95% CI, -13.7 to -4.4; p < 0.001) during titration. Collapse was changed by -9.9% (95% CI, -15.3 to -4.5; p < 0.001), while overdistension did not increase significantly (0.8%; 95% CI, -2.9 to 4.5; p = 0.650). A mean increase of the positive end-expiratory pressure level (1.4 mbar; 95% CI, 0.6-2.2; p = 0.008) occurred after titration. Global respiratory system compliance and gas exchange improved (global respiratory system compliance: 1.3 mL/mbar, 95% CI [-0.3 to 3.0], p = 0.026; Pao2: 17.6 mm Hg, 95% CI [7.8-27.5], p = 0.0039; and Pao2/Fio2 ratio: 55.2 mm Hg, 95% CI [27.3-83.2], p < 0.001, all values are change in pre vs post).ConclusionsElectrical impedance tomography-guided positive end-expiratory pressure titration reduced regional lung collapse without significant increase of overdistension, while improving global compliance and gas exchange in children with acute respiratory distress syndrome.

Dataset Information

The use of electrical impedance tomography for individualized ventilation strategy in COVID-19: a case report.

Background

Case presentation

Conclusion

Publications

The use of electrical impedance tomography for individualized ventilation strategy in COVID-19: a case report.

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