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Heines SJH, de Jongh SAM, Strauch U, van der Horst ICC, van de Poll MCG, Bergmans DCJJ. The global inhomogeneity index assessed by electrical impedance tomography overestimates PEEP requirement in patients with ARDS: an observational study. BMC Anesthesiol 2022; 22:258. [PMID: 35971060 PMCID: PMC9377133 DOI: 10.1186/s12871-022-01801-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Electrical impedance tomography (EIT) visualises alveolar overdistension and alveolar collapse and enables optimisation of ventilator settings by using the best balance between alveolar overdistension and collapse (ODCL). Besides, the global inhomogeneity index (GI), measured by EIT, may also be of added value in determining PEEP. Optimal PEEP is often determined based on the best dynamic compliance without EIT at the bedside. This study aimed to assess the effect of a PEEP trial on ODCL, GI and dynamic compliance in patients with and without ARDS. Secondly, PEEP levels from “optimal PEEP” approaches by ODCL, GI and dynamic compliance are compared. Methods In 2015–2016, we included patients with ARDS using postoperative cardiothoracic surgery patients as a reference group. A PEEP trial was performed with four consecutive incremental followed by four decremental PEEP steps of 2 cmH2O. Primary outcomes at each step were GI, ODCL and best dynamic compliance. In addition, the agreement between ODCL, GI, and dynamic compliance was determined for the individual patient. Results Twenty-eight ARDS and 17 postoperative cardiothoracic surgery patients were included. The mean optimal PEEP, according to best compliance, was 10.3 (±2.9) cmH2O in ARDS compared to 9.8 (±2.5) cmH2O in cardiothoracic surgery patients. Optimal PEEP according to ODCL was 10.9 (±2.5) in ARDS and 9.6 (±1.6) in cardiothoracic surgery patients. Optimal PEEP according to GI was 17.1 (±3.9) in ARDS compared to 14.2 (±3.4) in cardiothoracic surgery patients. Conclusions Currently, no golden standard to titrate PEEP is available. We showed that when using the GI, PEEP requirements are higher compared to ODCL and best dynamic compliance during a PEEP trial in patients with and without ARDS. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01801-7.
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Affiliation(s)
- Serge J H Heines
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands.
| | - Sebastiaan A M de Jongh
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - Ulrich Strauch
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands.,Department of Surgery, Maastricht University Medical Centre+, P. Debyelaan 25, 6229HX, Maastricht, the Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - Dennis C J J Bergmans
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
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