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Monitoring Lung Function with Electrical Impedance Tomography in the Intensive Care Unit
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Determination of optimal positive end-expiratory pressure using electrical impedance tomography in infants under

Ji-Hyun Lee1, Pyoyoon Kang1, Jung-Bin Park1

  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

Paediatric Anaesthesia
|May 2, 2024
PubMed

Insights

Mechanically ventilated infants require higher positive end-expiratory pressure in the prone position compared to the supine position. Electrical impedance tomography (EIT) aids in individualizing this optimal pressure.

Area of Science:

  • Anesthesiology
  • Pediatric Critical Care
  • Respiratory Physiology

Background:

  • Optimizing mechanical ventilation in infants undergoing surgery is crucial for patient outcomes.
  • Positive end-expiratory pressure (PEEP) management requires careful consideration of patient positioning.
  • Electrical impedance tomography (EIT) offers real-time, non-invasive assessment of lung ventilation distribution.

Purpose of the Study:

  • To determine the optimal PEEP levels in infants in both supine and prone positions under general anesthesia.
  • To evaluate the utility of EIT in guiding PEEP titration in different positions.
  • To compare ventilation parameters between supine and prone positions.

Main Methods:

  • Prospective observational study in infants undergoing prone surgery.
  • Application of EIT sensor after general anesthesia induction.
  • Decremental PEEP trials in supine position to determine optimal settings based on EIT and compliance.
  • Continuous monitoring of EIT parameters (e.g., inhomogeneity index, ventilation delay, opening pressure, center of ventilation, pendelluft volume) after prone positioning.
  • Determination of optimal PEEP in the prone position using similar methodology.

Main Results:

  • The mean EIT-based optimal PEEP was significantly higher in the prone position (10.9 cmH2O) than in the supine position (6.1 cmH2O) (p < .001).
  • Significant differences were noted between EIT- and compliance-based optimal PEEP.
  • Airway pressures (peak, mean, plateau, driving) increased 1 hour after prone positioning.
  • Ventilation balance between ventral and dorsal regions improved in the prone position, indicated by the center of ventilation.

Conclusions:

  • The prone position necessitates a higher PEEP compared to the supine position in mechanically ventilated infants under general anesthesia.
  • EIT is a valuable tool for identifying individualized optimal PEEP settings.
  • Further research may explore the long-term implications of these findings.
Abstract

Keywords:
electrical impedance tomographygeneral anesthesiainfantpositive end‐expiratory pressureprone position

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