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Positive end-expiratory pressure titration with electrical impedance tomography and pressure–volume curve in severe acute respiratory distress syndrome
Background The study objective was to compare titration of positive end-expiratory pressure (PEEP) with electrical impedance tomography (EIT) and with ventilator-embedded pressure–volume loop in severe acute respiratory distress syndrome (ARDS). Methods We have designed a prospective study with hist...
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| Published in: | Annals of intensive care 2019-01, Vol.9 (1), p.7-9, Article 7 |
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| creator | Zhao, Zhanqi Chang, Mei-Ying Chang, Mei-Yun Gow, Chien-Hung Zhang, Jia-Hao Hsu, Yeong-Long Frerichs, Inez Chang, Hou-Tai Möller, Knut |
| description | Background
The study objective was to compare titration of positive end-expiratory pressure (PEEP) with electrical impedance tomography (EIT) and with ventilator-embedded pressure–volume loop in severe acute respiratory distress syndrome (ARDS).
Methods
We have designed a prospective study with historical control group. Twenty-four severe ARDS patients (arterial oxygen partial pressure to fractional inspired oxygen ratio, PaO
2
/FiO
2
|
| doi_str_mv | 10.1186/s13613-019-0484-0 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_9b1d9a2d1aca4b90addb6dc82893d1ae</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_9b1d9a2d1aca4b90addb6dc82893d1ae</doaj_id><sourcerecordid>2168065801</sourcerecordid><originalsourceid>FETCH-LOGICAL-c603t-d2d32132e24cea6984ac395f7c9c07344fb93df0a5b17088aeecda4dec3da46c3</originalsourceid><addsrcrecordid>eNp1ks1u1DAQxyMEolXpA3BBkbhwCfgjcewLEqr4qFQJDnC2JvbsrleJHWxnYW-8AydejyfBZcvSIjEXW-Pf_Mce_6vqMSXPKZXiRaJcUN4QqhrSyrYh96pTRilpOsnI_Vv7k-o8pS0p0ZGeMf6wOuFEdKLt1Wn140NILrsd1uhtg19nFyGHuK_niCktEevsckm54OsvLm9qHNHk6AyMtZtmtOBNYcIU1hHmzb4Gb4-1P79934VxmbA2SywtnK8T7rCIglky1gU79rMu5euyOu29jWHCR9WDFYwJz2_Ws-rTm9cfL941V-_fXl68umqMIDw3llnOKGfIWoMglGzBcNWteqMM6XnbrgbF7YpAN9CeSAmIxkJr0fCyCMPPqsuDrg2w1XN0E8S9DuD070SIaw0xOzOiVgO1CpilYKAdFAFrB2GNZLK0oIBF6-VBa16GCa1BX2Y33hG9e-LdRq_DTgvORad4EXh2IxDD5wVT1pNLBscRPIYlaUZ7xWWJvqBP_0G3YYm-jKpQQpYfloQWih4oE0NKEVfHy1Cir32kDz7SxUf62kealJont19xrPjjmgKwA5DKkV9j_Nv6_6q_AJEH2v4</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2168065801</pqid></control><display><type>article</type><title>Positive end-expiratory pressure titration with electrical impedance tomography and pressure–volume curve in severe acute respiratory distress syndrome</title><source>PubMed Central (Open Access)</source><source>Publicly Available Content Database</source><source>Springer Nature - SpringerLink Journals - Fully Open Access </source><creator>Zhao, Zhanqi ; Chang, Mei-Ying ; Chang, Mei-Yun ; Gow, Chien-Hung ; Zhang, Jia-Hao ; Hsu, Yeong-Long ; Frerichs, Inez ; Chang, Hou-Tai ; Möller, Knut</creator><creatorcontrib>Zhao, Zhanqi ; Chang, Mei-Ying ; Chang, Mei-Yun ; Gow, Chien-Hung ; Zhang, Jia-Hao ; Hsu, Yeong-Long ; Frerichs, Inez ; Chang, Hou-Tai ; Möller, Knut</creatorcontrib><description>Background
The study objective was to compare titration of positive end-expiratory pressure (PEEP) with electrical impedance tomography (EIT) and with ventilator-embedded pressure–volume loop in severe acute respiratory distress syndrome (ARDS).
Methods
We have designed a prospective study with historical control group. Twenty-four severe ARDS patients (arterial oxygen partial pressure to fractional inspired oxygen ratio, PaO
2
/FiO
2
< 100 mmHg) were included in the EIT group and examined prospectively. Data from another 31 severe ARDS patients were evaluated retrospectively (control group). All patients were receiving medical care under identical general support guidelines and protective mechanical ventilation. The PEEP level selected in the EIT group was the intercept point of cumulated collapse and overdistension percentages curves. In the control group, optimal PEEP was selected 2 cmH
2
O above the lower inflection point on the static pressure–volume curve.
Results
Patients in the EIT group were younger (
P
< 0.05), and their mean plateau pressure was 1.5 cmH
2
O higher (
P
< 0.01). No differences in other baseline parameters such as APACHE II score, PaO
2
/FiO
2
, initial PEEP, driving pressure, tidal volume, and respiratory system compliance were found. Two hours after the first PEEP titration, significantly higher PEEP, compliance, and lower driving pressure were found in the EIT group (
P
< 0.01). Hospital survival rates were 66.7% (16 of 24 patients) in the EIT group and 48.4% (15 of 31) in the control group. Identical rates were found regarding the weaning success rate: 66.7% in the EIT group and 48.4% in the control group.
Conclusion
In severe ARDS patients, it was feasible and safe to guide PEEP titration with EIT at the bedside. As compared with pressure–volume curve, the EIT-guided PEEP titration may be associated with improved oxygenation, compliance, driving pressure, and weaning success rate. The findings encourage further randomized control study with a larger sample size and potentially less bias in the baseline data.
Trial Registration
NCT03112512</description><identifier>ISSN: 2110-5820</identifier><identifier>EISSN: 2110-5820</identifier><identifier>DOI: 10.1186/s13613-019-0484-0</identifier><identifier>PMID: 30656479</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Acute respiratory distress syndrome ; Anesthesiology ; Critical Care Medicine ; Electrical impedance tomography ; Emergency Medicine ; Intensive ; Intensive care ; Lung protective ventilation strategy ; Medicine ; Medicine & Public Health ; NCT ; NCT03112512 ; Pressure–volume curve ; Respiratory distress syndrome ; Respiratory therapy ; Titration of positive end-expiratory pressure ; Tomography ; Weaning</subject><ispartof>Annals of intensive care, 2019-01, Vol.9 (1), p.7-9, Article 7</ispartof><rights>The Author(s) 2019</rights><rights>Annals of Intensive Care is a copyright of Springer, (2019). All Rights Reserved. © 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c603t-d2d32132e24cea6984ac395f7c9c07344fb93df0a5b17088aeecda4dec3da46c3</citedby><cites>FETCH-LOGICAL-c603t-d2d32132e24cea6984ac395f7c9c07344fb93df0a5b17088aeecda4dec3da46c3</cites><orcidid>0000-0002-1279-2207</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2168065801/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2168065801?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30656479$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhao, Zhanqi</creatorcontrib><creatorcontrib>Chang, Mei-Ying</creatorcontrib><creatorcontrib>Chang, Mei-Yun</creatorcontrib><creatorcontrib>Gow, Chien-Hung</creatorcontrib><creatorcontrib>Zhang, Jia-Hao</creatorcontrib><creatorcontrib>Hsu, Yeong-Long</creatorcontrib><creatorcontrib>Frerichs, Inez</creatorcontrib><creatorcontrib>Chang, Hou-Tai</creatorcontrib><creatorcontrib>Möller, Knut</creatorcontrib><title>Positive end-expiratory pressure titration with electrical impedance tomography and pressure–volume curve in severe acute respiratory distress syndrome</title><title>Annals of intensive care</title><addtitle>Ann. Intensive Care</addtitle><addtitle>Ann Intensive Care</addtitle><description>Background
The study objective was to compare titration of positive end-expiratory pressure (PEEP) with electrical impedance tomography (EIT) and with ventilator-embedded pressure–volume loop in severe acute respiratory distress syndrome (ARDS).
Methods
We have designed a prospective study with historical control group. Twenty-four severe ARDS patients (arterial oxygen partial pressure to fractional inspired oxygen ratio, PaO
2
/FiO
2
< 100 mmHg) were included in the EIT group and examined prospectively. Data from another 31 severe ARDS patients were evaluated retrospectively (control group). All patients were receiving medical care under identical general support guidelines and protective mechanical ventilation. The PEEP level selected in the EIT group was the intercept point of cumulated collapse and overdistension percentages curves. In the control group, optimal PEEP was selected 2 cmH
2
O above the lower inflection point on the static pressure–volume curve.
Results
Patients in the EIT group were younger (
P
< 0.05), and their mean plateau pressure was 1.5 cmH
2
O higher (
P
< 0.01). No differences in other baseline parameters such as APACHE II score, PaO
2
/FiO
2
, initial PEEP, driving pressure, tidal volume, and respiratory system compliance were found. Two hours after the first PEEP titration, significantly higher PEEP, compliance, and lower driving pressure were found in the EIT group (
P
< 0.01). Hospital survival rates were 66.7% (16 of 24 patients) in the EIT group and 48.4% (15 of 31) in the control group. Identical rates were found regarding the weaning success rate: 66.7% in the EIT group and 48.4% in the control group.
Conclusion
In severe ARDS patients, it was feasible and safe to guide PEEP titration with EIT at the bedside. As compared with pressure–volume curve, the EIT-guided PEEP titration may be associated with improved oxygenation, compliance, driving pressure, and weaning success rate. The findings encourage further randomized control study with a larger sample size and potentially less bias in the baseline data.
Trial Registration
NCT03112512</description><subject>Acute respiratory distress syndrome</subject><subject>Anesthesiology</subject><subject>Critical Care Medicine</subject><subject>Electrical impedance tomography</subject><subject>Emergency Medicine</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Lung protective ventilation strategy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>NCT</subject><subject>NCT03112512</subject><subject>Pressure–volume curve</subject><subject>Respiratory distress syndrome</subject><subject>Respiratory therapy</subject><subject>Titration of positive end-expiratory pressure</subject><subject>Tomography</subject><subject>Weaning</subject><issn>2110-5820</issn><issn>2110-5820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp1ks1u1DAQxyMEolXpA3BBkbhwCfgjcewLEqr4qFQJDnC2JvbsrleJHWxnYW-8AydejyfBZcvSIjEXW-Pf_Mce_6vqMSXPKZXiRaJcUN4QqhrSyrYh96pTRilpOsnI_Vv7k-o8pS0p0ZGeMf6wOuFEdKLt1Wn140NILrsd1uhtg19nFyGHuK_niCktEevsckm54OsvLm9qHNHk6AyMtZtmtOBNYcIU1hHmzb4Gb4-1P79934VxmbA2SywtnK8T7rCIglky1gU79rMu5euyOu29jWHCR9WDFYwJz2_Ws-rTm9cfL941V-_fXl68umqMIDw3llnOKGfIWoMglGzBcNWteqMM6XnbrgbF7YpAN9CeSAmIxkJr0fCyCMPPqsuDrg2w1XN0E8S9DuD070SIaw0xOzOiVgO1CpilYKAdFAFrB2GNZLK0oIBF6-VBa16GCa1BX2Y33hG9e-LdRq_DTgvORad4EXh2IxDD5wVT1pNLBscRPIYlaUZ7xWWJvqBP_0G3YYm-jKpQQpYfloQWih4oE0NKEVfHy1Cir32kDz7SxUf62kealJont19xrPjjmgKwA5DKkV9j_Nv6_6q_AJEH2v4</recordid><startdate>20190117</startdate><enddate>20190117</enddate><creator>Zhao, Zhanqi</creator><creator>Chang, Mei-Ying</creator><creator>Chang, Mei-Yun</creator><creator>Gow, Chien-Hung</creator><creator>Zhang, Jia-Hao</creator><creator>Hsu, Yeong-Long</creator><creator>Frerichs, Inez</creator><creator>Chang, Hou-Tai</creator><creator>Möller, Knut</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><general>SpringerOpen</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-1279-2207</orcidid></search><sort><creationdate>20190117</creationdate><title>Positive end-expiratory pressure titration with electrical impedance tomography and pressure–volume curve in severe acute respiratory distress syndrome</title><author>Zhao, Zhanqi ; Chang, Mei-Ying ; Chang, Mei-Yun ; Gow, Chien-Hung ; Zhang, Jia-Hao ; Hsu, Yeong-Long ; Frerichs, Inez ; Chang, Hou-Tai ; Möller, Knut</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c603t-d2d32132e24cea6984ac395f7c9c07344fb93df0a5b17088aeecda4dec3da46c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acute respiratory distress syndrome</topic><topic>Anesthesiology</topic><topic>Critical Care Medicine</topic><topic>Electrical impedance tomography</topic><topic>Emergency Medicine</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Lung protective ventilation strategy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>NCT</topic><topic>NCT03112512</topic><topic>Pressure–volume curve</topic><topic>Respiratory distress syndrome</topic><topic>Respiratory therapy</topic><topic>Titration of positive end-expiratory pressure</topic><topic>Tomography</topic><topic>Weaning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhao, Zhanqi</creatorcontrib><creatorcontrib>Chang, Mei-Ying</creatorcontrib><creatorcontrib>Chang, Mei-Yun</creatorcontrib><creatorcontrib>Gow, Chien-Hung</creatorcontrib><creatorcontrib>Zhang, Jia-Hao</creatorcontrib><creatorcontrib>Hsu, Yeong-Long</creatorcontrib><creatorcontrib>Frerichs, Inez</creatorcontrib><creatorcontrib>Chang, Hou-Tai</creatorcontrib><creatorcontrib>Möller, Knut</creatorcontrib><collection>SpringerOpen</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>Annals of intensive care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhao, Zhanqi</au><au>Chang, Mei-Ying</au><au>Chang, Mei-Yun</au><au>Gow, Chien-Hung</au><au>Zhang, Jia-Hao</au><au>Hsu, Yeong-Long</au><au>Frerichs, Inez</au><au>Chang, Hou-Tai</au><au>Möller, Knut</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Positive end-expiratory pressure titration with electrical impedance tomography and pressure–volume curve in severe acute respiratory distress syndrome</atitle><jtitle>Annals of intensive care</jtitle><stitle>Ann. Intensive Care</stitle><addtitle>Ann Intensive Care</addtitle><date>2019-01-17</date><risdate>2019</risdate><volume>9</volume><issue>1</issue><spage>7</spage><epage>9</epage><pages>7-9</pages><artnum>7</artnum><issn>2110-5820</issn><eissn>2110-5820</eissn><abstract>Background
The study objective was to compare titration of positive end-expiratory pressure (PEEP) with electrical impedance tomography (EIT) and with ventilator-embedded pressure–volume loop in severe acute respiratory distress syndrome (ARDS).
Methods
We have designed a prospective study with historical control group. Twenty-four severe ARDS patients (arterial oxygen partial pressure to fractional inspired oxygen ratio, PaO
2
/FiO
2
< 100 mmHg) were included in the EIT group and examined prospectively. Data from another 31 severe ARDS patients were evaluated retrospectively (control group). All patients were receiving medical care under identical general support guidelines and protective mechanical ventilation. The PEEP level selected in the EIT group was the intercept point of cumulated collapse and overdistension percentages curves. In the control group, optimal PEEP was selected 2 cmH
2
O above the lower inflection point on the static pressure–volume curve.
Results
Patients in the EIT group were younger (
P
< 0.05), and their mean plateau pressure was 1.5 cmH
2
O higher (
P
< 0.01). No differences in other baseline parameters such as APACHE II score, PaO
2
/FiO
2
, initial PEEP, driving pressure, tidal volume, and respiratory system compliance were found. Two hours after the first PEEP titration, significantly higher PEEP, compliance, and lower driving pressure were found in the EIT group (
P
< 0.01). Hospital survival rates were 66.7% (16 of 24 patients) in the EIT group and 48.4% (15 of 31) in the control group. Identical rates were found regarding the weaning success rate: 66.7% in the EIT group and 48.4% in the control group.
Conclusion
In severe ARDS patients, it was feasible and safe to guide PEEP titration with EIT at the bedside. As compared with pressure–volume curve, the EIT-guided PEEP titration may be associated with improved oxygenation, compliance, driving pressure, and weaning success rate. The findings encourage further randomized control study with a larger sample size and potentially less bias in the baseline data.
Trial Registration
NCT03112512</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>30656479</pmid><doi>10.1186/s13613-019-0484-0</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1279-2207</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2110-5820 |
| ispartof | Annals of intensive care, 2019-01, Vol.9 (1), p.7-9, Article 7 |
| issn | 2110-5820 2110-5820 |
| language | eng |
| recordid | cdi_doaj_primary_oai_doaj_org_article_9b1d9a2d1aca4b90addb6dc82893d1ae |
| source | PubMed Central (Open Access); Publicly Available Content Database; Springer Nature - SpringerLink Journals - Fully Open Access |
| subjects | Acute respiratory distress syndrome Anesthesiology Critical Care Medicine Electrical impedance tomography Emergency Medicine Intensive Intensive care Lung protective ventilation strategy Medicine Medicine & Public Health NCT NCT03112512 Pressure–volume curve Respiratory distress syndrome Respiratory therapy Titration of positive end-expiratory pressure Tomography Weaning |
| title | Positive end-expiratory pressure titration with electrical impedance tomography and pressure–volume curve in severe acute respiratory distress syndrome |
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