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Biomedical Engineering / Biomedizinische Technik

Joint Journal of the German Society for Biomedical Engineering in VDE and the Austrian and Swiss Societies for Biomedical Engineering and the German Society of Biomaterials

Editor-in-Chief: Dössel, Olaf

Editorial Board: Augat, Peter / Habibović, Pamela / Haueisen, Jens / Jahnen-Dechent, Wilhelm / Jockenhoevel, Stefan / Knaup-Gregori, Petra / Lenarz, Thomas / Leonhardt, Steffen / Plank, Gernot / Radermacher, Klaus M. / Schkommodau, Erik / Stieglitz, Thomas / Boenick, Ulrich / Jaramaz, Branislav / Kraft, Marc / Lenthe, Harry / Lo, Benny / Mainardi, Luca / Micera, Silvestro / Penzel, Thomas / Robitzki, Andrea A. / Schaeffter, Tobias / Snedeker, Jess G. / Sörnmo, Leif / Sugano, Nobuhiko / Werner, Jürgen /


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1862-278X
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Volume 64, Issue 2

Issues

Volume 57 (2012)

Determination of optimal positive end-expiratory pressure based on respiratory compliance and electrical impedance tomography: a pilot clinical comparative trial

Jan Karsten
  • Corresponding author
  • Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany
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/ Nicolas Voigt
  • Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany
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/ Hans-Joerg Gillmann
  • Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany
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/ Thomas Stueber
  • Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany
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Published Online: 2018-06-06 | DOI: https://doi.org/10.1515/bmt-2017-0103

Abstract

There is no agreement on gold standard method for positive end-expiratory pressure (PEEP) titration. Electrical impedance tomography (EIT) may aid in finding the optimal PEEP level. In this pilot trial, we investigated potential differences in the suggested optimal PEEP (BestPEEP) as derived by respiratory compliance and EIT-derived parameters. We examined if compliance-derived PEEP differs with regard to the regional ventilation distribution in relation to atelectasis and hyperinflation. Measurements were performed during an incremental/decremental PEEP trial in 15 ventilated intensive care patients suffering from mild-to-moderate impairment of oxygenation due to sepsis, pneumonia, trauma and metabolic and ischemic disorders. Measurement agreement was analyzed using Bland-Altman plots. We observed a diversity of EIT-derived and compliance-based optimal PEEP in the evaluated patients. BestPEEPCompliance did not necessarily correspond to the BestPEEPODCL with the least regional overdistension and collapse. The collapsed area was significantly smaller when the overdistension/collapse index was used for PEEP definition (p=0.022). Our results showed a clinically relevant difference in the suggested optimal PEEP levels when using different parameters for PEEP titration. The compliance-derived PEEP level revealed a higher proportion of residual regional atelectasis as compared to EIT-based PEEP.

Keywords: compliance; critical care; diagnostic imaging; mechanical ventilation

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About the article

Corresponding author: Dr. Jan Karsten, Department of Anaesthesiology and Intensive Care Medicine OE 8050, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany, Phone: +49-176-1532 5648, Fax: +49-511-532 3498


Received: 2017-06-27

Accepted: 2018-05-04

Published Online: 2018-06-06

Published in Print: 2019-04-24


Author Statement

Research funding: Authors state no funding involved.

Conflict of interest: Authors state no conflict of interest.

Informed consent: Written informed consent has been obtained from all individuals.

Ethical approval: The research related to human use complied with all the relevant national regulations and institutional policies, was performed in accordance with the tenets of the Helsinki Declaration, and has been approved by the local Ethics Committee (Ethics committee Hannover Medical School; Prof. Dr. H.D. Troeger, protocol number 2013-6429, 02.05.2013).


Citation Information: Biomedical Engineering / Biomedizinische Technik, Volume 64, Issue 2, Pages 135–145, ISSN (Online) 1862-278X, ISSN (Print) 0013-5585, DOI: https://doi.org/10.1515/bmt-2017-0103.

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