Chen Rongqing, Guy Ella F S, Clifton Jaimey A, Chase J Geoffrey, Rupitsch Stefan J, Moeller Knut
Institute of Technical Medicine, Hochschule Furtwangen, Villingen-Schwenningen, Germany; Department of Microsystems Engineering (IMTEK), Faculty of Engineering, University of Freiburg, Freiburg, Germany.
Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand.
Comput Methods Programs Biomed. 2025 Nov;271:108992. doi: 10.1016/j.cmpb.2025.108992. Epub 2025 Jul 25.
Therapies such as positive airway pressure (PAP), which maintain positive end-expiratory pressure (PEEP) settings, are widely used in the management of respiratory diseases. However, most research has focused on patient outcomes, such as oxygenation, mortality rates, or ventilator-free days. There is a lack of focus on lung-specific responses, for example, atelectasis rate or aeration heterogeneities. This study aims to use Electrical Impedance Tomography (EIT) to investigate variations in lung aeration heterogeneity with increasing PEEP and how factors such as sex, smoking/vaping history, asthma, and BMI influence lung aeration dynamics.
Eighty participants were recruited and categorized into four groups: asthmatics, smokers, vapers, and healthy individuals. Each group comprises 20 subjects evenly distributed by sex (10 females and 10 males). Varying PEEP was applied on each subject during the trial, which began at zero end-expiratory pressure (ZEEP) and subsequently increased from 4 to 12 cmHO on non-invasive ventilation (NIV). EIT data were collected at each pressure level. Lung aeration heterogeneity was assessed using regional ventilation delay (RVD), a promising metric derived from EIT data for evaluating lung-specific responses to mechanical ventilation. RVD and its standard deviation (SDRVD) of each subject were calculated accordingly at ZEEP and the highest PEEP level.
Results demonstrated that female participants exhibited a significant increase in RVD when pressure was elevated from ZEEP to higher levels, whereas male participants showed no such significant change. Overweight subjects experienced no significant alterations in RVD under highest PEEP, whereas non-overweight subjects showed significantly increased RVD under higher pressure levels. Vaping was associated with a statistically significant increase in RVD when pressure was at the highest PEEP level, whereas no significant RVD changes were observed among smokers or subjects with mild asthma within this relatively young population.
These findings emphasize the importance of considering individualized factors when optimizing respiratory therapy, including sex and BMI. These factors significantly influence regional lung aeration and ventilation dynamics, and play important roles in optimising mechanical ventilation settings, which could potentially enhance therapeutic effectiveness and patient outcomes.
诸如持续气道正压通气（PAP）等维持呼气末正压（PEEP）设置的治疗方法广泛应用于呼吸系统疾病的管理。然而，大多数研究集中在患者的预后，如氧合、死亡率或无呼吸机天数。对于肺部特异性反应关注不足，例如肺不张发生率或通气不均一性。本研究旨在使用电阻抗断层成像（EIT）来研究随着PEEP增加肺通气不均一性的变化，以及性别、吸烟/吸电子烟史、哮喘和体重指数等因素如何影响肺通气动力学。
招募了80名参与者并分为四组：哮喘患者、吸烟者、吸电子烟者和健康个体。每组包括20名受试者，按性别均匀分布（10名女性和10名男性）。在试验期间，对每个受试者施加不同的PEEP，试验从呼气末零压力（ZEEP）开始，随后在无创通气（NIV）时从4 cmH₂O增加到12 cmH₂O。在每个压力水平收集EIT数据。使用区域通气延迟（RVD）评估肺通气不均一性，RVD是一种从EIT数据得出的有前景的指标，用于评估肺部对机械通气的特异性反应。在ZEEP和最高PEEP水平相应计算每个受试者的RVD及其标准差（SDRVD）。
结果表明，当压力从ZEEP升高到更高水平时，女性参与者的RVD显著增加，而男性参与者没有这种显著变化。超重受试者在最高PEEP下RVD无显著改变，而非超重受试者在较高压力水平下RVD显著增加。当压力处于最高PEEP水平时，吸电子烟与RVD的统计学显著增加相关，而在这个相对年轻的人群中，吸烟者或轻度哮喘患者未观察到RVD的显著变化。
这些发现强调了在优化呼吸治疗时考虑个体因素（包括性别和体重指数）的重要性。这些因素显著影响局部肺通气和通气动力学，并在优化机械通气设置中发挥重要作用，这可能会提高治疗效果和患者预后。
