Perioperative assessment of regional ventilation during changing body positions and ventilation conditions by electrical impedance tomography
© The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissionsoup.com..
BACKGROUND: Lung-protective ventilation is claimed to be beneficial not only in critically ill patients, but also in pulmonary healthy patients undergoing general anaesthesia. We report the use of electrical impedance tomography for assessing regional changes in ventilation, during both spontaneous breathing and mechanical ventilation, in patients undergoing robot-assisted radical prostatectomy.
METHODS: We performed electrical impedance tomography measurements in 39 patients before induction of anaesthesia in the sitting (M1) and supine position (M2), after the start of mechanical ventilation (M3), during capnoperitoneum and Trendelenburg positioning (M4), and finally, in the supine position after release of capnoperitoneum (M5). To quantify regional changes in lung ventilation, we calculated the centre of ventilation and 'silent spaces' in the ventral and dorsal lung regions that did not show major impedance changes.
RESULTS: Compared with the awake supine position [2.3% (2.3)], anaesthesia and mechanical ventilation induced a significant increase in silent spaces in the dorsal dependent lung [9.2% (6.3); P<0.05]. Capnoperitoneum and the Trendelenburg position led to a significant increase in such spaces [11.5% (8.9)]. Silent space in the ventral lung remained constant throughout anaesthesia.
CONCLUSION: Electrical impedance tomography was able to identify and quantify on a breath-by-breath basis circumscribed areas, so-called silent spaces, within healthy lungs that received little or no ventilation during general anaesthesia, capnoperitoneum, and different body positions. As these silent spaces are suggestive of atelectasis on the one hand and overdistension on the other, they might become useful to guide individualized protective ventilation strategies to mitigate the side-effects of anaesthesia and surgery on the lungs.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2016 |
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| Erschienen: |
2016 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:117 |
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| Enthalten in: |
British journal of anaesthesia - 117(2016), 2 vom: 01. Aug., Seite 228-35 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ukere, A [VerfasserIn] |
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| Links: |
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| Themen: |
Atelectasis |
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| Anmerkungen: |
Date Completed 01.08.2018 Date Revised 01.08.2018 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/bja/aew188 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
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| 245 | 1 | 0 | |a Perioperative assessment of regional ventilation during changing body positions and ventilation conditions by electrical impedance tomography |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: Lung-protective ventilation is claimed to be beneficial not only in critically ill patients, but also in pulmonary healthy patients undergoing general anaesthesia. We report the use of electrical impedance tomography for assessing regional changes in ventilation, during both spontaneous breathing and mechanical ventilation, in patients undergoing robot-assisted radical prostatectomy | ||
| 520 | |a METHODS: We performed electrical impedance tomography measurements in 39 patients before induction of anaesthesia in the sitting (M1) and supine position (M2), after the start of mechanical ventilation (M3), during capnoperitoneum and Trendelenburg positioning (M4), and finally, in the supine position after release of capnoperitoneum (M5). To quantify regional changes in lung ventilation, we calculated the centre of ventilation and 'silent spaces' in the ventral and dorsal lung regions that did not show major impedance changes | ||
| 520 | |a RESULTS: Compared with the awake supine position [2.3% (2.3)], anaesthesia and mechanical ventilation induced a significant increase in silent spaces in the dorsal dependent lung [9.2% (6.3); P<0.05]. Capnoperitoneum and the Trendelenburg position led to a significant increase in such spaces [11.5% (8.9)]. Silent space in the ventral lung remained constant throughout anaesthesia | ||
| 520 | |a CONCLUSION: Electrical impedance tomography was able to identify and quantify on a breath-by-breath basis circumscribed areas, so-called silent spaces, within healthy lungs that received little or no ventilation during general anaesthesia, capnoperitoneum, and different body positions. As these silent spaces are suggestive of atelectasis on the one hand and overdistension on the other, they might become useful to guide individualized protective ventilation strategies to mitigate the side-effects of anaesthesia and surgery on the lungs | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a atelectasis | |
| 650 | 4 | |a electrical impedance | |
| 650 | 4 | |a electrodes | |
| 650 | 4 | |a perioperative period | |
| 650 | 4 | |a respiration, artificial | |
| 700 | 1 | |a März, A |e verfasserin |4 aut | |
| 700 | 1 | |a Wodack, K H |e verfasserin |4 aut | |
| 700 | 1 | |a Trepte, C J |e verfasserin |4 aut | |
| 700 | 1 | |a Haese, A |e verfasserin |4 aut | |
| 700 | 1 | |a Waldmann, A D |e verfasserin |4 aut | |
| 700 | 1 | |a Böhm, S H |e verfasserin |4 aut | |
| 700 | 1 | |a Reuter, D A |e verfasserin |4 aut | |
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