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Research ArticleOriginal Research

Dynamic Relative Regional Lung Strain Estimated by Electrical Impedance Tomography in an Experimental Model of ARDS

Emiliano Gogniat, Matías Madorno, Pablo O Rodriguez, José Dianti, Pablo E Otero, Lisa Krukewitt, Stephan H Böhm, Eduardo San Roman and Gerardo Tusman
Respiratory Care August 2022, 67 (8) 906-913; DOI: https://doi.org/10.4187/respcare.09682
Emiliano Gogniat
Department of Intensive Care Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; and Instituto Tecnológico Buenos Aires, Buenos Aires, Argentina.
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Matías Madorno
Instituto Tecnológico Buenos Aires, Buenos Aires, Argentina; and MBMed SA, Buenos Aires, Argentina.
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Pablo O Rodriguez
Pulmonary and Critical Care Medicine, Instituto Universitario CEMIC (Centro de Educación Médica e Investigaciones Clínicas), Buenos Aires, Argentina.
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José Dianti
Department of Intensive Care Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Pablo E Otero
Anesthesia Department, Veterinary School, Universidad de Buenos Aires, Buenos Aires, Argentina.
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Lisa Krukewitt
Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany.
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Stephan H Böhm
Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany.
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Eduardo San Roman
Department of Intensive Care Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Gerardo Tusman
Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: To analyze the role of PEEP on dynamic relative regional strain (DRRS) in a model of ARDS, respective maps were generated by electrical impedance tomography (EIT).

METHODS: Eight ARDS pigs submitted to PEEP steps of 0, 5, 10, and 15 cm H2O at fixed ventilation were evaluated by EIT images. DRRS was calculated as (VT-EIT/EELI)/(VT-EIT[15PEEP]/EELI[15PEEP]), where the tidal volume (VT)-EIT and end-expiratory lung impedance (EELI) are the tidal and end-expiratory change in lung impedance, respectively. The measurement at 15 PEEP was taken as reference (end-expiratory transpulmonary pressure > 0 cm H2O). The relationship between EIT variables (center of ventilation, EELI, and DRRS) and airway pressures was assessed with mixed-effects models using EIT measurements as dependent variables and PEEP as fixed-effect variable.

RESULTS: At constant ventilation, respiratory compliance increased progressively with PEEP (lowest value at zero PEEP 10 ± 3 mL/cm H2O and highest value at 15 PEEP 16 ± 6 mL/cm H2O; P < .001), whereas driving pressure decreased with PEEP (highest value at zero PEEP 34 ± 6 cm H2O and lowest value at 15 PEEP 21 ± 4 cm H2O; P < .001). The mixed-effect regression models showed that the center of ventilation moved to dorsal lung areas with a slope of 1.81 (1.44–2.18) % points by each cm H2O of PEEP; P < .001. EELI increased with a slope of 0.05 (0.02–0.07) (arbitrary units) for each cm H2O of PEEP; P < .001. DRRS maps showed that local strain in ventral lung areas decreased with a slope of −0.02 (−0.24 to 0.15) with each cm H2O increase of PEEP; P < .001.

CONCLUSIONS: EIT-derived DRRS maps showed high strain in ventral lung zones at low levels of PEEP. The findings suggest overdistention of the baby lung.

  • overdistension
  • PEEP
  • lung strain
  • EIT
  • ARDS
  • VILI

Footnotes

  • Correspondence: Gerardo Tusman MD, Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina. E-mail: gtusman{at}hotmail.com
  • See the Related Editorial on Page 1061

  • Dr Tusman wrote a patent regarding electrical impedance tomography and lung strain. Dr Madorno is partner and manager of MBMed SA. Mr Gogniat is currently employed by Medtronic Argentina. The remaining authors have disclosed no conflicts of interest.

  • This study was performed at the Hospital Veterinario Universitario de la Universidad de Buenos Aires, Buenos Aires, Argentina.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (8)
Respiratory Care
Vol. 67, Issue 8
1 Aug 2022
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Dynamic Relative Regional Lung Strain Estimated by Electrical Impedance Tomography in an Experimental Model of ARDS
Emiliano Gogniat, Matías Madorno, Pablo O Rodriguez, José Dianti, Pablo E Otero, Lisa Krukewitt, Stephan H Böhm, Eduardo San Roman, Gerardo Tusman
Respiratory Care Aug 2022, 67 (8) 906-913; DOI: 10.4187/respcare.09682

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Dynamic Relative Regional Lung Strain Estimated by Electrical Impedance Tomography in an Experimental Model of ARDS
Emiliano Gogniat, Matías Madorno, Pablo O Rodriguez, José Dianti, Pablo E Otero, Lisa Krukewitt, Stephan H Böhm, Eduardo San Roman, Gerardo Tusman
Respiratory Care Aug 2022, 67 (8) 906-913; DOI: 10.4187/respcare.09682
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Keywords

  • overdistension
  • PEEP
  • lung strain
  • EIT
  • ARDS
  • VILI

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