Krauss Ekaterina, van der Beck Daniel, Schmalz Isabel, Wilhelm Jochen, Tello Silke, Dartsch Ruth C, Mahavadi Poornima, Korfei Martina, Teschner Eckhard, Seeger Werner, Guenther Andreas
Member of the German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center (UGMLC), Klinikstr. 33, 35392 Giessen, Germany.
European IPF Registry & Biobank (eurIPFreg), 35392 Giessen, Germany.
J Clin Med. 2021 Jan 7;10(2):192. doi: 10.3390/jcm10020192.
In idiopathic pulmonary fibrosis (IPF), alterations in the pulmonary surfactant system result in an increased alveolar surface tension and favor repetitive alveolar collapse. This study aimed to assess the usefulness of electrical impedance tomography (EIT) in characterization of regional ventilation in IPF.
We investigated 17 patients with IPF and 15 healthy controls from the University of Giessen and Marburg Lung Center (UGMLC), Germany, for differences in the following EIT parameters: distribution of ventilation (TID), global inhomogeneity index (GI), regional impedance differences through the delta of end-expiratory lung impedance (dEELI), differences in surface of ventilated area (SURF), as well as center of ventilation (CG) and intratidal gas distribution (ITV). These parameters were assessed under spontaneous breathing and following a predefined escalation protocol of the positive end-expiratory pressure (PEEP), applied through a face mask by an intensive care respirator (EVITA, Draeger, Germany).
Individual slopes of dEELI over the PEEP increment protocol were found to be highly significantly increased in both groups ( < 0.001) but were not found to be significantly different between groups. Similarly, dTID slopes were increasing in response to PEEP, but this did not reach statistical significance within or between groups. Individual breathing patterns were very heterogeneous. There were no relevant differences of SURF, GI or CGVD over the PEEP escalation range. A correlation of dEELI to FVC, BMI, age, or weight did not forward significant results.
In this study, we did see a significant increase in dEELI and a non-significant increase in dTID in IPF patients as well as in healthy controls in response to an increase of PEEP under spontaneous breathing. We propose the combined measurements of EIT and lung function to assess regional lung ventilation in spontaneously breathing subjects.
在特发性肺纤维化（IPF）中，肺表面活性物质系统的改变会导致肺泡表面张力增加，并促使肺泡反复萎陷。本研究旨在评估电阻抗断层成像（EIT）在IPF区域通气特征描述中的作用。
我们对来自德国吉森大学和马尔堡肺中心（UGMLC）的17例IPF患者和15名健康对照者进行了研究，比较以下EIT参数的差异：通气分布（TID）、整体不均匀性指数（GI）、通过呼气末肺阻抗差值（dEELI）得出的区域阻抗差异、通气区域表面积差异（SURF），以及通气中心（CG）和潮气内气体分布（ITV）。这些参数在自主呼吸状态下以及在通过重症监护呼吸机（德国德尔格公司的EVITA）经面罩施加的呼气末正压（PEEP）按照预定义递增方案进行操作后进行评估。
发现两组中dEELI在PEEP递增方案下的个体斜率均显著升高（<0.001），但两组之间无显著差异。同样，dTID斜率随PEEP增加而升高，但在组内或组间均未达到统计学显著性。个体呼吸模式非常不均匀。在PEEP递增范围内，SURF、GI或CGVD无相关差异。dEELI与FVC、BMI、年龄或体重之间的相关性未得出显著结果。
在本研究中，我们确实观察到在自主呼吸状态下，IPF患者和健康对照者在PEEP增加时，dEELI显著升高，dTID有非显著性升高。我们建议联合使用EIT和肺功能测量来评估自主呼吸受试者的区域肺通气。
