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. 2020 Jul 15;202(2):280-284.
doi: 10.1164/rccm.202003-0816LE.

Electrical Impedance Tomography for Positive End-Expiratory Pressure Titration in COVID-19-related Acute Respiratory Distress Syndrome

Philip van der Zee  1 , Peter Somhorst  1 , Henrik Endeman  1 , Diederik Gommers  1
Affiliations

Electrical Impedance Tomography for Positive End-Expiratory Pressure Titration in COVID-19-related Acute Respiratory Distress Syndrome

Philip van der Zee et al. Am J Respir Crit Care Med. .
No abstract available

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Figures

Figure 1.
Figure 1.
Total set positive end-expiratory pressure (PEEP) based on electrical impedance tomography. (A) Ventilation distribution at four levels of PEEP. The top row shows the ventilation distribution in blue, whereas the bottom row shows relative alveolar overdistention in orange and relative alveolar collapse in white. The percentages of relative alveolar overdistention and collapse are presented as well. At a total PEEP of 29 cm H2O, the dorsal areas of the lung are mainly ventilated, whereas the ventral parts are not ventilated because of overdistention. At a total PEEP of 9 cm H2O, the ventral parts are mainly ventilated (with more ventilation in the right lung than the left lung), and the dorsal parts are not ventilated because of alveolar collapse. At a total PEEP between 15 and 21 cm H2O, ventilation is mainly distributed to the center. (B) Relative alveolar overdistention, collapse, and dynamic compliance. Relative alveolar overdistention and collapse and the dynamic compliance of the respiratory system are shown during a decremental PEEP trial. At 29 cm H2O PEEP, there is relative alveolar overdistention but no relative collapse, whereas at 9 cm H2O PEEP, there is relative alveolar collapse but no relative overdistention. The total PEEP was set at the PEEP level above the intersection of the curves representing relative alveolar overdistention and collapse, in this case 21 cm H2O (6). Images: Pulmovista 500, Dräger.
Figure 2.
Figure 2.
(A) Total set positive end-expiratory pressure (PEEPset) versus higher and lower PEEP–FiO2 tables. The solid and dashed lines represent the PEEP–FiO2 combination to be used according to the lower and higher PEEP–FiO2 tables from the ALVEOLI trial. Each marker represents PEEPset at the level of lowest relative alveolar overdistention and collapse as measured with electrical impedance tomography. Only the first PEEP trial of each patient is presented. The crosses indicate subjects who died within 28 days following ICU admission. There was no correlation between PEEPset and FiO2 (ρ = 0.11; P = 0.69). (B) PEEPset versus body mass index (BMI). The correlation between BMI and PEEPset after the first PEEP trial for each patient is shown. Spearman’s rank correlation coefficient ρ = 0.76 with P = 0.001. Similar markers in Figures 2A and 2B represent the same patient. (C) Change in PEEP compared with the first PEEP trial. The change in PEEPset compared with the first PEEP trial is represented by the median (orange lines), interquartile ranges (boxes), and minimum and maximum values (whiskers). PEEPset did not change significantly over time. The number between parentheses represents the number of patients measured at that day.
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