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Regional air trapping in acute exacerbation of obstructive lung diseases measured with electrical impedance tomography: a feasibility study.

Abstract

BACKGROUND

Since bronchial abnormalities often exhibit spatial non-uniformity which may be not correctly assessed by conventional global lung function measures, regional information may help to characterize the disease progress. We hypothesized that regional air trapping during mechanical ventilation could be characterized by regional end-expiratory flow (EEF) derived from electrical impedance tomography (EIT).

METHODS

Twenty-five patients suffering from chronic obstructive pulmonary disease (COPD grade 3 or 4) or severe asthma with acute exacerbation were examined prospectively. Patients were ventilated under assist-control mode. EIT measurements were conducted before and one hour after inhaled combined corticosteroid and long-acting β2 agonist, on two consecutive days. Regional EEF was calculated as derivative of relative impedance for every image pixel in the lung regions. The results were normalized to global flow values measured by the ventilator.

RESULTS

Regional and global EEF were highly correlated (p<0.00001) and regional effects of medication and disease progression were visible in the regional EEF maps. The sums of regional EEF in lung regions were 3.8 [2.0, 5.1] and 3.6 [1.9, 4.5] L/min in COPD patients before and after medication (median [lower, upper quartiles]; p=0.37). The corresponding values in asthma patients were 3.0 [2.5, 4.2] and 2.2 [1.7, 3.2] L/min (p<0.05). Histograms of regional EEF showed high spatial heterogeneity of EEF before medication. After one day of treatment, the histograms exhibited less heterogeneous and a decrease in EEF level.

CONCLUSIONS

Regional EEF characterizes air trapping and intrinsic PEEP, which could provide diagnostic information for monitoring the disease progress during treatment.

Authors+Show Affiliations

Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China - zhanqi.zhao@hs-furtwangen.de. Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany - zhanqi.zhao@hs-furtwangen.de.Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre of Schleswig-Holstein Campus Kiel, Kiel, Germany.Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31808658

Citation

Zhao, Zhanqi, et al. "Regional Air Trapping in Acute Exacerbation of Obstructive Lung Diseases Measured With Electrical Impedance Tomography: a Feasibility Study." Minerva Anestesiologica, 2019.
Zhao Z, Chang MY, Frerichs I, et al. Regional air trapping in acute exacerbation of obstructive lung diseases measured with electrical impedance tomography: a feasibility study. Minerva Anestesiol. 2019.
Zhao, Z., Chang, M. Y., Frerichs, I., Zhang, J. H., Chang, H. T., Gow, C. H., & Möller, K. (2019). Regional air trapping in acute exacerbation of obstructive lung diseases measured with electrical impedance tomography: a feasibility study. Minerva Anestesiologica, doi:10.23736/S0375-9393.19.13732-7.
Zhao Z, et al. Regional Air Trapping in Acute Exacerbation of Obstructive Lung Diseases Measured With Electrical Impedance Tomography: a Feasibility Study. Minerva Anestesiol. 2019 Dec 4; PubMed PMID: 31808658.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Regional air trapping in acute exacerbation of obstructive lung diseases measured with electrical impedance tomography: a feasibility study. AU - Zhao,Zhanqi, AU - Chang,Mei-Yun, AU - Frerichs,Inez, AU - Zhang,Jia-Hao, AU - Chang,Hao-Tai, AU - Gow,Chien-Hung, AU - Möller,Knut, Y1 - 2019/12/04/ PY - 2019/12/7/entrez PY - 2019/12/7/pubmed PY - 2019/12/7/medline JF - Minerva anestesiologica JO - Minerva Anestesiol N2 - BACKGROUND: Since bronchial abnormalities often exhibit spatial non-uniformity which may be not correctly assessed by conventional global lung function measures, regional information may help to characterize the disease progress. We hypothesized that regional air trapping during mechanical ventilation could be characterized by regional end-expiratory flow (EEF) derived from electrical impedance tomography (EIT). METHODS: Twenty-five patients suffering from chronic obstructive pulmonary disease (COPD grade 3 or 4) or severe asthma with acute exacerbation were examined prospectively. Patients were ventilated under assist-control mode. EIT measurements were conducted before and one hour after inhaled combined corticosteroid and long-acting β2 agonist, on two consecutive days. Regional EEF was calculated as derivative of relative impedance for every image pixel in the lung regions. The results were normalized to global flow values measured by the ventilator. RESULTS: Regional and global EEF were highly correlated (p<0.00001) and regional effects of medication and disease progression were visible in the regional EEF maps. The sums of regional EEF in lung regions were 3.8 [2.0, 5.1] and 3.6 [1.9, 4.5] L/min in COPD patients before and after medication (median [lower, upper quartiles]; p=0.37). The corresponding values in asthma patients were 3.0 [2.5, 4.2] and 2.2 [1.7, 3.2] L/min (p<0.05). Histograms of regional EEF showed high spatial heterogeneity of EEF before medication. After one day of treatment, the histograms exhibited less heterogeneous and a decrease in EEF level. CONCLUSIONS: Regional EEF characterizes air trapping and intrinsic PEEP, which could provide diagnostic information for monitoring the disease progress during treatment. SN - 1827-1596 UR - https://www.unboundmedicine.com/medline/citation/31808658/Regional_air_trapping_in_acute_exacerbation_of_obstructive_lung_diseases_measured_with_electrical_impedance_tomography:_a_feasibility_study L2 - https://www.minervamedica.it/index2.t?show=R02Y9999N00A19120403 DB - PRIME DP - Unbound Medicine ER -