基于EIT技术监测ARDS小猪模型PEEP滴定的实验研究
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摘要
目的基于电阻抗断层成像(Electrical Impedance Tomography,EIT)技术监测急性呼吸窘迫综合征(Acute Respiratory Distress Syndrome,ARDS)小猪模型机械通气时的呼气末正压(Positive End-Expiratory Pressure,PEEP)滴定过程,比较研究呼吸机动态顺应性参数(C_(dyn))和EIT指标指导最佳PEEP值设定是否存在差异。方法油酸静脉注射法复制小猪ARDS模型(n=9),实施标准肺复张,由20～0 cmH_2O每隔2 cmH_2O实施PEEP滴定,同步实施EIT监测,记录动态顺应性等呼吸机通气参数。采用数据后处理方法对EIT数据进行分析,求取GI和F两项指标以评价肺局部区域均匀性和膨胀塌陷程度。结果 C_(dyn)、GI和F确定的最佳PEEP分别为(9.00±0.71)、(7.78±1.20)和(3.33±1.41)cmH_2O。C_(dyn)、GI指导的最佳PEEP和F指导的最佳PEEP有显著统计学差异(P<0.05),C_(dyn)指导的最佳PEEP和GI指导的最佳PEEP无显著统计学差异(P>0.05)。结论相较于传统方法,EIT技术为本实验中ARDS小猪模型最佳PEEP的设定提供了可视化依据。本实验为临床应用打下了基础,GI和F等EIT指标在开展EIT监测肺复张和PEEP滴定的实验研究中具有应用潜力。
Objective To determine whether there was a difference between the ventilator dynamic compliance parameters (C_(dyn)) and electrical impedance tomography imaging(EIT) indicators in the optimal positive end-expiratory pressure(PEEP) value setting via a comparative study based on EIT technology to monitor acute respiratory distress syndrome(ARDS) pig models that were out of PEEP titration process. Methods The ARDS piglet models were induced by intravenously infusing oleic acid(n=9). A standard recruitment maneuver was implemented following descending PEEP trial in steps of 2 cm H_2O from PEEP 20 cm H_2O to 0 cm H_2O. During all PEEP steps, C_(dyn) and other ventilation parameters were recorded and EIT indices, GI and F were calculated to evaluate the homogeneity and degree of overdistention and collapse of lung area. Results Compared with F(3.33±1.41) method, the optimal PEEP(cm H_2O) determined by optimal C_(dyn) method(9.00±0.71), GI method(7.78±1.20) had significant differences(P<0.05). The values guided by C_(dyn) method and GI method had no significant differences(P>0.05). Conclusion Compared with the traditional method, the EIT technology provides visual basis to set optimal PEEP for ARDS piglet models. This experiment establishes the foundation for clinical trials research and the EIT indices, GI and F have potential applications for monitoring lung recruitment manoeuver and PEEP titration.
Objective To determine whether there was a difference between the ventilator dynamic compliance parameters (C_(dyn)) and electrical impedance tomography imaging(EIT) indicators in the optimal positive end-expiratory pressure(PEEP) value setting via a comparative study based on EIT technology to monitor acute respiratory distress syndrome(ARDS) pig models that were out of PEEP titration process. Methods The ARDS piglet models were induced by intravenously infusing oleic acid(n=9). A standard recruitment maneuver was implemented following descending PEEP trial in steps of 2 cm H_2O from PEEP 20 cm H_2O to 0 cm H_2O. During all PEEP steps, C_(dyn) and other ventilation parameters were recorded and EIT indices, GI and F were calculated to evaluate the homogeneity and degree of overdistention and collapse of lung area. Results Compared with F(3.33±1.41) method, the optimal PEEP(cm H_2O) determined by optimal C_(dyn) method(9.00±0.71), GI method(7.78±1.20) had significant differences(P<0.05). The values guided by C_(dyn) method and GI method had no significant differences(P>0.05). Conclusion Compared with the traditional method, the EIT technology provides visual basis to set optimal PEEP for ARDS piglet models. This experiment establishes the foundation for clinical trials research and the EIT indices, GI and F have potential applications for monitoring lung recruitment manoeuver and PEEP titration.
引文
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[6]Shaefi S,Eikermann M.Analysing tidal volumes early after a positive end-expiratory pressure increase:a new way to determine optimal PEEP in the operating theatre?[J].Br JAnaesth,2018,120(4):623-626.
[7]董秀珍.生物电阻抗技术研究进展[J].中国医学物理学杂志,2004,21(6):311-317.
[8]Kobylianskii J,Murray A,Brace D,et al.Electrical impedance tomography in adult patients undergoing mechanical ventilation:A systematic review[J].J Crit Care,2016,35:33-50.
[9]Ferguson ND,Fan E,Camporota L,et al.The Berlin definition of ARDS:an expanded rationale,justification,and supplementary material[J].Intens Care Med,2012,38(10):1573-1582.
[10]Karsten J,Grusnick C,Paarmann H,et al.Positive end-expiratory pressure titration at bedside using electrical impedance tomography in post-operative cardiac surgery patients[J].Acta Anaesthesiol Scand,2015,59(6):723-732.
[11]Adler A.EIDORS:Electrical Impedance Tomography and Diffuse Optical Tomography Reconstruction Software[EB/OL].(2018-05-21)[2017-03-25].http://www.sce.carleton.ca/faculty/adler/eidors/index.shtml.
[12]Adler A,Arnold JH,Bayford R,et al.GREIT:a unified approach to 2D linear EIT reconstruction of lung images[J].Physiol Meas,2009,30(6):S35-S55.
[13]Pulletz S,van Genderingen HR,Schmitz G,et al.Comparison of different methods to define regions of interest for evaluation of regional lung ventilation by EIT[J].Physiol Meas,2006,27(5):S115-127.
[14]Zhao Z,Moller K,Steinmann D,et al.Evaluation of an electrical impedance tomography-based Global Inhomogeneity Index for pulmonary ventilation distribution[J].Intens Care Med,2009,35(11):1900-1906.
[15]Costa ELV,Borges JB,Melo A,et al.Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography[J].Intens Care Med,2009,35(6):1132-1137.
[16]Bikker IG,Blankman P,Specht P,et al.Global and regional parameters to visualize the‘best’PEEP during a PEEP trial in a porcine model with and without acute lung injury[J].Minerva Anestesiol,2013,79(9):983-992.
[17]Blankman P,Hasan D,Erik G,et al.Detection of‘best’positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial[J].Crit Care,2014,18(3):R95.
[2]朱蕾.机械通气[M].4版.上海:上海科学技术出版社,2017.
[3]Adler A,Amato MB,Arnold JH,et al.Whither lung EIT:where are we,where do we want to go and what do we need to get there?[J].Physiol Meas,2012,33(5):679-694.
[4]Caironi P,Cressoni M,Chiumello D,et al.Lung opening and closing during ventilation of acute respiratory distress syndrome[J].Am J Respir Crit Care Med,2010,181(6):578-586.
[5]边伟帅,晁彦公,陈炜,等.4种方法滴定急性呼吸窘迫综合征动物模型最佳呼气末正压效果的比较[J].吉林大学学报(医学版),2013,39(6):1132-1137.
[6]Shaefi S,Eikermann M.Analysing tidal volumes early after a positive end-expiratory pressure increase:a new way to determine optimal PEEP in the operating theatre?[J].Br JAnaesth,2018,120(4):623-626.
[7]董秀珍.生物电阻抗技术研究进展[J].中国医学物理学杂志,2004,21(6):311-317.
[8]Kobylianskii J,Murray A,Brace D,et al.Electrical impedance tomography in adult patients undergoing mechanical ventilation:A systematic review[J].J Crit Care,2016,35:33-50.
[9]Ferguson ND,Fan E,Camporota L,et al.The Berlin definition of ARDS:an expanded rationale,justification,and supplementary material[J].Intens Care Med,2012,38(10):1573-1582.
[10]Karsten J,Grusnick C,Paarmann H,et al.Positive end-expiratory pressure titration at bedside using electrical impedance tomography in post-operative cardiac surgery patients[J].Acta Anaesthesiol Scand,2015,59(6):723-732.
[11]Adler A.EIDORS:Electrical Impedance Tomography and Diffuse Optical Tomography Reconstruction Software[EB/OL].(2018-05-21)[2017-03-25].http://www.sce.carleton.ca/faculty/adler/eidors/index.shtml.
[12]Adler A,Arnold JH,Bayford R,et al.GREIT:a unified approach to 2D linear EIT reconstruction of lung images[J].Physiol Meas,2009,30(6):S35-S55.
[13]Pulletz S,van Genderingen HR,Schmitz G,et al.Comparison of different methods to define regions of interest for evaluation of regional lung ventilation by EIT[J].Physiol Meas,2006,27(5):S115-127.
[14]Zhao Z,Moller K,Steinmann D,et al.Evaluation of an electrical impedance tomography-based Global Inhomogeneity Index for pulmonary ventilation distribution[J].Intens Care Med,2009,35(11):1900-1906.
[15]Costa ELV,Borges JB,Melo A,et al.Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography[J].Intens Care Med,2009,35(6):1132-1137.
[16]Bikker IG,Blankman P,Specht P,et al.Global and regional parameters to visualize the‘best’PEEP during a PEEP trial in a porcine model with and without acute lung injury[J].Minerva Anestesiol,2013,79(9):983-992.
[17]Blankman P,Hasan D,Erik G,et al.Detection of‘best’positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial[J].Crit Care,2014,18(3):R95.