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Licensed Unlicensed Requires Authentication Published by De Gruyter June 6, 2018

Determination of optimal positive end-expiratory pressure based on respiratory compliance and electrical impedance tomography: a pilot clinical comparative trial

  • Jan Karsten EMAIL logo , Nicolas Voigt , Hans-Joerg Gillmann and Thomas Stueber

Abstract

There is no agreement on gold standard method for positive end-expiratory pressure (PEEP) titration. Electrical impedance tomography (EIT) may aid in finding the optimal PEEP level. In this pilot trial, we investigated potential differences in the suggested optimal PEEP (BestPEEP) as derived by respiratory compliance and EIT-derived parameters. We examined if compliance-derived PEEP differs with regard to the regional ventilation distribution in relation to atelectasis and hyperinflation. Measurements were performed during an incremental/decremental PEEP trial in 15 ventilated intensive care patients suffering from mild-to-moderate impairment of oxygenation due to sepsis, pneumonia, trauma and metabolic and ischemic disorders. Measurement agreement was analyzed using Bland-Altman plots. We observed a diversity of EIT-derived and compliance-based optimal PEEP in the evaluated patients. BestPEEPCompliance did not necessarily correspond to the BestPEEPODCL with the least regional overdistension and collapse. The collapsed area was significantly smaller when the overdistension/collapse index was used for PEEP definition (p=0.022). Our results showed a clinically relevant difference in the suggested optimal PEEP levels when using different parameters for PEEP titration. The compliance-derived PEEP level revealed a higher proportion of residual regional atelectasis as compared to EIT-based PEEP.


Corresponding author: Dr. Jan Karsten, Department of Anaesthesiology and Intensive Care Medicine OE 8050, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany, Phone: +49-176-1532 5648, Fax: +49-511-532 3498

Acknowledgments

We would like to thank Professor Wolfgang Koppert (Head of the Department of Anaesthesiology and Intensive Care Medicine), Dr. Heiner Ruschulte (senior attending specialist and Head of Division of Intensive Care Medicine, Department of Anaesthesiology and Intensive Care Intensive Care Medicine) and Dr. Josef Lang (senior attending specialist and Head of Division of Intensive Care Medicine, Department of Neurosurgery) for their continuous support. The study protocol was approved by the local Ethics Committee of the Hannover Medical School (Chair: Prof. Hans-Dieter Troeger; Carl-Neuberg-Str. 1, 30625 Hannover, Germany). The study was supported by the Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School. The EIT system PulmoVista 500 (including hardware and software) was provided by Dräger Medical GmbH, Lübeck, Germany.

  1. Author Statement

  2. Research funding: Authors state no funding involved.

  3. Conflict of interest: Authors state no conflict of interest.

  4. Informed consent: Written informed consent has been obtained from all individuals.

  5. Ethical approval: The research related to human use complied with all the relevant national regulations and institutional policies, was performed in accordance with the tenets of the Helsinki Declaration, and has been approved by the local Ethics Committee (Ethics committee Hannover Medical School; Prof. Dr. H.D. Troeger, protocol number 2013-6429, 02.05.2013).

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Received: 2017-06-27
Accepted: 2018-05-04
Published Online: 2018-06-06
Published in Print: 2019-04-24

©2019 Walter de Gruyter GmbH, Berlin/Boston

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