Continuous noninvasive monitoring of lung recruitment during high-frequency oscillatory ventilation by electrical impedance measurement: an animal study.

Abstract:

BACKGROUND:Ventilatory pressures should target the range between the upper and lower inflection point of the pressure volume curve in order to avoid atelecto- and volutrauma. During high-frequency oscillatory ventilation (HFOV), this range is difficult to determine. Quadrant impedance measurement (QIM) has recently been shown to allow accurate and precise measurement of lung volume changes during conventional mechanical ventilation. OBJECTIVES:To investigate if QIM can be used to determine a static pressure-residual impedance curve during a recruitment-derecruitment manoeuvre on HFOV and to monitor the time course of alveolar recruitment after changing mean airway pressure (MAP). METHODS:An incremental and decremental MAP trial (6 cm H2O to 27 cm H2O) was conducted in five surfactant-depleted newborn piglets during HFOV. Ventilatory, gas exchange and haemodynamic parameters were recorded. Continuous measurement of thoracic impedance change was performed. RESULTS:Mean residual impedance (RI) increased with each stepwise increase of MAP resulting in a total mean increase of +26.5% (±4.0) at the highest MAP (27 cm H2O) compared to baseline ventilation at 6 cm H2O. Upon decreasing MAP levels, RI fell more slowly compared to its ascent; 83.4% (±19.1) and 84.8% (±16.4) of impedance changes occurred in the first 5 min after an increase or decrease in airway pressure, respectively. CONCLUSIONS:QIM could be used for continuous monitoring of thoracic impedance and determination of the pressure-RI curve during HFOV. The method could prove to be a promising bedside method for the monitoring of lung recruitment during HFOV in the future.

journal_name

Neonatology

journal_title

Neonatology

authors

Burkhardt W,Kurth F,Pitterle M,Blassnig N,Wemhöner A,Rüdiger M

doi

10.1159/000345612

subject

Has Abstract

pub_date

2013-01-01 00:00:00

pages

218-23

issue

3

eissn

1661-7800

issn

1661-7819

pii

000345612

journal_volume

103

pub_type

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