Integrating electrical impedance tomography and transpulmonary pressure monitoring to personalize PEEP in hypoxemic patients undergoing pressure support ventilation
Douglas Slobod,
Marco Leali,
Elena Spinelli,
Domenico Luca Grieco,
Savino Spadaro,
Tommaso Mauri
Affiliations
Douglas Slobod
Department of Anesthesia, Critical Care and Emergency, Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico
Marco Leali
Department of Pathophysiology and Transplantation, University of Milan
Elena Spinelli
Department of Anesthesia, Critical Care and Emergency, Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico
Domenico Luca Grieco
Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS
Savino Spadaro
Anesthesia and Intensive Care Unit, Department of Translational Medicine, University of Ferrara
Tommaso Mauri
Department of Anesthesia, Critical Care and Emergency, Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico
Abstract Monitoring with electrical impedance tomography (EIT) during a decremental PEEP trial has been used to identify the PEEP that yields the optimal balance of pulmonary overdistension and collapse. This method is based on pixel-level changes in respiratory system compliance and depends on fixed or measured airway driving pressure. We developed a novel approach to quantify overdistension and collapse during pressure support ventilation (PSV) by integrating transpulmonary pressure and EIT monitoring and performed pilot tests in three hypoxemic patients. We report that our experimental approach is feasible and capable of identifying a PEEP that balances overdistension and collapse in intubated hypoxemic patients undergoing PSV.
