Luepschen H, Meier T, Grossherr M, Leibecke T, Karsten J, Leonhardt S
Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrasse 20, D-52074 Aachen, Germany.
Physiol Meas. 2007 Jul;28(7):S247-60. doi: 10.1088/0967-3334/28/7/S18. Epub 2007 Jun 26.
Dynamic thoracic EIT is capable of detecting changes of the ventilation distribution in the lung. Nevertheless, it has yet to become an established clinical tool. Therefore, it is necessary to consider application scenarios wherein fast and distinct changes of the tissue conductivities are to be found and also have a clear diagnostic significance. One such a scenario is the artificial ventilation of patients suffering from the acute respiratory distress syndrome (ARDS). New protective ventilation strategies involving recruitment manoeuvres are associated with noticeable shifts of body fluids and regional ventilation, which can quite easily be detected by EIT. The bedside assessment of these recruitment manoeuvres will help the attending physician to optimize treatment. Hence, we performed an animal study of lavage-induced lung failure and investigated if EIT is capable of qualitatively as well as quantitatively monitoring lung recruitment during a stepwise PEEP trial. Additionally, we integrated EIT into a fuzzy controller-based ventilation system which allows one to perform automated recruitment manoeuvres (open lung concept) based on online PaO2 measurements. We found that EIT is a useful tool to titrate the proper PEEP level after fully recruiting the lung. Furthermore, EIT seems to be able to determine the status of recruitment when combining it with other physiological parameters. These results suggest that EIT may play an important role in the individualization of protective ventilation strategies.
动态胸部电阻抗断层成像（EIT）能够检测肺部通气分布的变化。然而，它尚未成为一种成熟的临床工具。因此，有必要考虑那些能够发现组织电导率快速且明显变化并有明确诊断意义的应用场景。急性呼吸窘迫综合征（ARDS）患者的人工通气就是这样一种场景。涉及肺复张手法的新型保护性通气策略会伴随着明显的体液转移和局部通气变化，而EIT能够很容易地检测到这些变化。对这些肺复张手法进行床旁评估将有助于主治医生优化治疗。因此，我们进行了一项关于灌洗诱导性肺衰竭的动物研究，并调查了在逐步进行呼气末正压（PEEP）试验期间，EIT是否能够定性和定量地监测肺复张情况。此外，我们将EIT集成到基于模糊控制器的通气系统中，该系统能够根据在线动脉血氧分压（PaO2）测量值进行自动肺复张手法（开放肺概念）。我们发现，EIT是在肺充分复张后滴定合适PEEP水平的有用工具。此外，当将EIT与其他生理参数相结合时，似乎能够确定肺复张状态。这些结果表明，EIT可能在保护性通气策略的个体化方面发挥重要作用。
