electrical impedance tomography ; new marker for lung...
TRANSCRIPT
Electrical Impedance Tomography
; New Marker for Lung Protective Strategy in ARDS?
Department of Intensive Care Medicine
Department of Pulmonology
Dong Hyun, LEE
Conflict of Interest
• Drager Korea
• Pulmovista 500: Free demonstration (2 months)
• EIT analysis software (EIT analysis tool 6.3)
• Savina 300 Ventilator: Free demonstration (2 months)
• Planned to equip additional mechanical ventilator (4)
Electrical Impedance Tomography전기 임피던스? 단층촬영
Electrical Impedance Tomography전기 임피던스? 단층촬영
임피던스 (Impedance)- 저항 (비슷한 것)- 교류의 저항
Electrical Impedance Tomography
Electrical Impedance Tomography
Phys. Physiol. Meas. 1985;6:109
Electrical Impedance Tomography
Phys. Physiol. Meas. 1985;6:109
Electrical Impedance Tomography
Phys. Physiol. Meas. 1985;6:109
Electrical Impedance Tomography
Electrical Impedance Tomography
Phys. Physiol. Meas. 1985;6:109
EIT at Present
How to Measure EIT?
Electric Impedance Tomography
Phys. Physiol. Meas. 1985;6:109
Visualize!!
Electric Impedance Tomography
Phys. Physiol. Meas. 1985;6:109
Impedance의 차이 (변화)를수치로 제공할 수 있다.
Tidal Variation
Tidal Variationof
Impedance
Tidal Variation
Electric Impedance Tomography
Phys. Physiol. Meas. 1985;6:109
부분 별 impedance의 값을 알 수 있다.
Tidal Variation
Tidal Variation & Tidal Volume
Equine Veterinary Journal51(2019) 222–226
Tidal Variation & Tidal Volume
Electrical Impedance Tomography, Dräger Medical
① Tidal Volume② Tidal Variation
TV
EIT for Pulmonary Monitoring
Non-Invasive & Radiation Free
TV (Tidal Variation) (of Impedance)
Global & Regional TV (360 segments)
Real Time (50 /sec)
Tidal Volume during HFNC
J Appl Physiol. 2013;114(8):1058-1065 / Respir Care. 2013;58(4):589-596
HFNC만 달아도 폐 환기가 좋아진다!!
폐의 모든 부위에서 일관되게 증가할까?
• > 20 years
• Subjective dyspnea
• SaO2 < 90% in room air
• Unstable vital sign
– SBP < 90 mmHg
– DBP < 60 mmHg
– HR > 120 bpm
– RR > 30 bpm
– Persistent dyspnea with NP
• PaO2/FiO2 < 200 mmHg
• Unable to cooperate
• Symptomatic IHD
• Labored breathing
• Impossibility of HFNC or NP application (facial deformity)
Acute Crit Care. 2018;33(1):7-15
Regional Ventilation Assessment with EIT
Quadrants
Q1 Q2
Q4Q3
Layers
L1
L2
L4
L3
Quadrangular Plane Dorso-ventral Plane
Acute Crit Care. 2018;33(1):7-15
Global Ventilation with EIT
Higher tidal variation
with HFNC
≒
Higher tidal volume
with HFNC 22412543
500
1000
1500
2000
2500
3000
3500
4000
Nasal Cannula HFNC
p < 0.001TidalVariation
Acute Crit Care. 2018;33(1):7-15
Quadrangular Distribution of Ventilation
436.2413.2
796.3
527.4513.4488.5
885.8
576.3
200
400
600
800
Q1 Q2 Q3 Q4
NC HFNC
TidalVariation
p = 0.014p = 0.042
p = 0.050
p = 0.027
Acute Crit Care. 2018;33(1):7-15
Regional Ventilation Distribution of Lung
Minimal & Maximum Ventilated Quadrant
121.7
167.5
100
200
NC HFNC
1101.7
1188.3
800
1000
1200
NC HFNC
p = 0.056
p = 0.035
37.6% 7.9%
TidalVariation
TidalVariation
Acute Crit Care. 2018;33(1):7-15
HFNC Favors Hypo-Ventilated Lung
Acute Crit Care. 2018;33(1):7-15
EIT during Endotracheal Intubation
British Journal of Anaesthesia 101 (3): 411–18 (2008)
EIT for Pneumothorax Detection
Crit Care Med 2008; 36:1230–1238
EIT of Healthy Lung
EIT of OOOOOOO???
Drager, Pulmovista 500 Manual
• Unilateral left dorsal pleural effusion
?
EIT of OOOOOOO???
Drager, Pulmovista 500 Manual
• Patient after right pneumectomy
?
EIT of OOOOOOO???
Drager, Pulmovista 500 Manual
?
EIT of OOOOOOO???
Drager, Pulmovista 500 Manual
• ARDS patient
?
EIT는 Regional Ventilation Defect를 잘 찾아낼까?
Drager, Pulmovista 500 Manual
Regional Ventilation; EIT vs CT
Am J Resp Cric Care Med; 2004:169:7
Regional Ventilation; EIT vs Electron beam CT
Chest. 2003;124:314–22
Lung with ARDS
Br J Anaesth 2004; 92: 261±70
Ventilator Induced Lung Injury, VILI
VILI in ARDS
Br J Anaesth 2004; 92: 261±70
BarotraumaVolutrauma
Atelectrauma
Stretch Injury (Overdistension)
Lung Protective Ventilation
Lung Protective Ventilation
Low Tidal Volume Ventilation
Limit Plateau Airway Pressure
Proper PEEP Titration
Prone Positioning
Recruit Maneuver
Overdistension
Overdistension
Atelectrauma
Atelectrauma
Atelectrauma
OverdistensionECMO
VILI in ARDS
Br J Anaesth 2004; 92: 261±70
EIT를 이용하면Overdistension 되었거나,
collapse 된 alveoli를 확인할 수 있다?
EIT for Overdistended Alveoli Detection
Intensive Care Med (2009) 35:1132–1137
Finding Overdistended Alveolous
PEEP: 8 / TV: 150
PEEP: 2 / TV: 100
PEEP: 14 / TV: 100
PEEP: 20 / TV: 50
PEEP & Tidal Variation in a Single Alveolous
0
30
60
90
120
150
180
24 20 16 12 8 4
PEEP
TidalVariation
PEEP & Tidal Variation in a Single Alveolous
0
30
60
90
120
150
180
24 20 16 12 8 4
TidalVariation
PEEP
PEEP & Tidal Variation in a Single Alveolous
0
30
60
90
120
150
180
24 20 16 12 8 4
TidalVariation
PEEP
Intensive Care Med (2009) 35:1132–1137
Finding Best PEEP Level!!
Segments of EIT
• 340 element
• 50 EITs / sec
Decremental PEEP Trial
PEEP Trial Analysis
PEEP Trial Analysis
PEEP Trial Analysis
PEEP Trial Analysis
PEEP Trial Analysis
PEEP Trial Analysis
Clinical Application of EIT for ARDS
• Lung collapse & overdistension
• Recruitable alveoli prediction
• Detecting airway closure
• Pneumothorax detection
• Ventilator dyssynchrony
• Regional ventilation delay
Regional Ventilation Delay
Filtering Raw EIT Data
Thorax 2017;72:83–93
Anesth Analg. 2018 Jan;126(1):102-110
Respiration. 2009;77:282–91.
EIT
Electrical Impedance Tomography
• Non-Invasive
• Radiation free
• Real time
• Promising (development → clinical application)
Electrical Impedance Tomography in ARDS
• Brand new Information
• Efficacy in MV / ARDS / …
• Further studies…