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Monitoring Lung Function with Electrical Impedance Tomography in the Intensive Care Unit
Published on: September 6, 2024
Effect of individualized PEEP titrated by EIT on postoperative atelectasis in children undergoing laparoscopy: A
Sheng-Hua Wang1, Ye Wang2, Si-Yuan Li1
1Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China.
Insights
Individualized positive end-expiratory pressure (PEEP) titration using electrical impedance tomography (EIT) significantly reduced postoperative atelectasis in children undergoing laparoscopic surgery. This lung protective ventilation strategy improved outcomes compared to fixed PEEP.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Postoperative atelectasis is a frequent complication in pediatric patients, particularly during laparoscopic procedures.
- While positive end-expiratory pressure (PEEP) is recognized for its lung-protective benefits, optimal PEEP levels for preventing atelectasis remain debated.
- Electrical impedance tomography (EIT) offers a method for real-time, individualized monitoring of lung ventilation.
Purpose of the Study:
- To investigate whether individualized PEEP titration guided by EIT can decrease the incidence and severity of postoperative atelectasis in children.
- To compare the efficacy of EIT-directed PEEP versus a fixed PEEP strategy in pediatric laparoscopic surgery patients.
Main Methods:
- A randomized controlled trial involving 50 children (2-7 years) undergoing laparoscopic hernia repair.
- Two groups: Control group received a fixed PEEP of 5 mmHg; Experimental group received individualized PEEP titrated by EIT.
- Lung atelectasis assessed using lung ultrasonography (consolidation and B-lines scores) at multiple time points (post-intubation, post-surgery, post-extubation).
Main Results:
- The incidence of postoperative atelectasis was significantly lower in the EIT group (64%) compared to the control group (92%) (P=0.037).
- Atelectasis incidence 1 hour post-extubation was also reduced in the EIT group (48%) versus the control group (80%) (P=0.038).
- The EIT group demonstrated significantly lower lung consolidation and B-lines scores post-surgery and post-extubation, and experienced less desaturation post-extubation.
Conclusions:
- EIT-guided individualized PEEP titration is an effective strategy for reducing the incidence and severity of postoperative atelectasis in pediatric laparoscopic surgery.
- This approach enhances lung protection and may improve respiratory outcomes in pediatric surgical patients.
Abstract:
Background: Atelectasis is common during perioperative period in children. Although positive end positive end-expiratory pressure (PEEP) has been identified as a lung protective ventilation strategy to alleviate atelectasis, there's still no consensus on the optimal value of PEEP. We hypothesized that individualized PEEP titrated by electrical impedance tomography (EIT) may reduce the incidence of postoperative atelectasis. Methods: A total of 50 children aged between 2 to 7, undergoing laparoscopic hernia repair, were randomly divided into two groups according to the principle of randomization: a control group (PEEP5) and an experimental group (EIT). In the control group, PEEP was set to a fixed value of 5mmHg during pneumoperitoneum mechanical ventilation. The EIT group received an individualized PEEP determined by a decremental PEEP titration using EIT. Ultrasonic assessment and score of atelectasis were carried out post-intubation, post-surgery, and one hour post-extubation. For this study, a total of 12 lung regions were evaluated by Lung ultrasonography, and significant atelectasis was defined by a consolidation score of at least 2 in any region. The primary outcome was the incidence of atelectasis at post-surgery. Results: The incidence of atelectasis after surgery was 92% in the control groups (n=25) and 64% in the EIT groups (n=25), respectively (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.094 to 4.827; P = 0.037). The incidence of atelectasis after 1h post-extubation was 80% in the control groups (n=20) and 48% in the EIT groups (n=12), respectively (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.149 to 2.215; P = 0.038). Both lung consolidations and B-lines score were significantly higher in control group than in the EIT group after surgery (consolidations: 9 vs. 7, P = 0.027; B-lines: 11 vs. 8, P = 0.002) and 1h post-extubation (consolidations: 7 vs. 4, P = 0.018; B-lines: 7 vs. 5, P = 0.037). Lung compliance using optimal PEEP during mechanical ventilation was 20.0±3.3 ml/cm H2O. The desaturation (pulse oximeter value is below 95%) after extubation was observed in 7 in the control group and 1 in the EIT group (P = 0.048). Hemodynamics were stable during titration. Conclusion: EIT-directed individualized PEEP titration can reduce the incidence and severity of postoperative atelectasis in children undergoing laparoscopic surgery.
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