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Alonso-Ojembarrena A, Aldecoa-Bilbao V, De Luca D. Imaging of bronchopulmonary dysplasia. Semin Perinatol 2023; 47:151812. [PMID: 37775364 DOI: 10.1016/j.semperi.2023.151812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Bronchopulmonary dysplasia (BPD) is a multifactorial disease with many associated co-morbidities, responsible for most cases of chronic lung disease in childhood. The use of imaging exams is pivotal for the clinical care of BPD and the identification of candidates for experimental therapies and a closer follow-up. Imaging is also useful to improve communication with the family and objectively evaluate the clinical evolution of the patient's disease. BPD imaging has been classically performed using only chest X-rays, but several modern techniques are currently available, such as lung ultrasound, thoracic tomography, magnetic resonance imaging and electrical impedance tomography. These techniques are more accurate and provide clinically meaningful information. We reviewed the most recent evidence published in the last five years regarding these techniques and analyzed their advantages and disadvantages.
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Affiliation(s)
- Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz. Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA). Research Unit, Puerta del Mar University Hospital, Cádiz. Spain.
| | - Victoria Aldecoa-Bilbao
- Neonatology Department, Hospital Clinic Barcelona. BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine. Barcelona, Spain
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Center, Paris- Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris-Saclay University, Paris, France; Department of Pediatrics, Division of Neonatology, Stanford University, School of Medicine, Palo Alto, CA, USA
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Ribeiro De Santis Santiago R, Xin Y, Gaulton TG, Alcala G, León Bueno de Camargo ED, Cereda M, Britto Passos Amato M, Berra L. Lung Imaging Acquisition with Electrical Impedance Tomography: Tackling Common Pitfalls. Anesthesiology 2023; 139:329-341. [PMID: 37402247 DOI: 10.1097/aln.0000000000004613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Electrical impedance tomography is a powerful tool for lung imaging that can be employed at the bedside in multiple clinical scenarios. Diagnosing and preventing interpretation pitfalls will ensure reliable data and allow for appropriate clinical decision-making.
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Affiliation(s)
- Roberta Ribeiro De Santis Santiago
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yi Xin
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy G Gaulton
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Glasiele Alcala
- Pulmonary Division, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Erick Dario León Bueno de Camargo
- Federal University of ABC/Engineering, Modeling and Applied Social Sciences Centre, Biomedical Engineering, São Bernardo do Campo, Brazil
| | - Maurizio Cereda
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Yang L, Fu F, Frerichs I, Moeller K, Dai M, Zhao Z. The calculation of electrical impedance tomography based silent spaces requires individual thorax and lung contours. Physiol Meas 2022; 43. [PMID: 35995039 DOI: 10.1088/1361-6579/ac8bc2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/22/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The present study evaluates the influence of different thorax contours (generic vs individual) on the parameter "silent spaces" computed from electrical impedance tomography (EIT) measurements. APPROACH Six patients with acute respiratory distress syndrome were analyzed retrospectively. EIT measurements were performed and the silent spaces were calculated based on (1) patient-specific contours Sind, (2) generic adult male contours SEidorsA and (3) generic neonate contours SEidorsN. MAIN RESULTS The differences among all studied subjects were 5±6% and 8±7% for Sind vs. SEidorsA, Sind vs. SEidorsN, respectively (median ± interquartile range). Sind values were higher than the generic ones in two patients. SIGNIFICANCE In the present study, we demonstrated the differences in values when the silent spaces were calculated based on different body and organ contours. To our knowledge, this study was the first one showing explicitly that silent spaces calculated with generic thorax and lung contours might lead to results with different locations and values as compared to the calculation with subject-specific models. Interpretations of silent spaces should be proceeded with caution.
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Affiliation(s)
- Lin Yang
- Fourth Military Medical University, Xi'an, Xi'an, 710032, CHINA
| | - Feng Fu
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, Xi'an, 710000, CHINA
| | - Inez Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein Campus Kiel, Kiel, Kiel, x, GERMANY
| | - Knut Moeller
- Institute of Technical Medicine, Furtwangen University, Jakob-Kienzle-Strasse 17, Villingen-Schwenningen, D-78054, GERMANY
| | - Meng Dai
- Biomedical Engineering Department, Fourth Military Medical University, 17 Changlex West Road, Xian, Shaanxi 710033, PR CHINA, Xi'an, 710000, CHINA
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, Xi'an, 710032, CHINA
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Zhang C, Wang Y, Liu L, Li Q, Li Y, Li N, Xi J, Jiang H, Fu F, Frerichs I, Möller K, Zhao Z. Regional ventilation distribution in patients with scoliosis assessed by electrical impedance tomography: is individual thorax shape required? Respir Physiol Neurobiol 2022; 299:103854. [DOI: 10.1016/j.resp.2022.103854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/20/2022] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
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Thomson J, Rüegger CM, Perkins EJ, Pereira-Fantini PM, Farrell O, Owen LS, Tingay DG. Regional ventilation characteristics during non-invasive respiratory support in preterm infants. Arch Dis Child Fetal Neonatal Ed 2021; 106:370-375. [PMID: 33246967 DOI: 10.1136/archdischild-2020-320449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/14/2020] [Accepted: 11/03/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To determine the regional ventilation characteristics during non-invasive ventilation (NIV) in stable preterm infants. The secondary aim was to explore the relationship between indicators of ventilation homogeneity and other clinical measures of respiratory status. DESIGN Prospective observational study. SETTING Two tertiary neonatal intensive care units. PATIENTS Forty stable preterm infants born <30 weeks of gestation receiving either continuous positive airway pressure (n=32) or high-flow nasal cannulae (n=8) at least 24 hours after extubation at time of study. INTERVENTIONS Continuous electrical impedance tomography imaging of regional ventilation during 60 min of quiet breathing on clinician-determined non-invasive settings. MAIN OUTCOME MEASURES Gravity-dependent and right-left centre of ventilation (CoV), percentage of whole lung tidal volume (VT) by lung region and percentage of lung unventilated were determined for 120 artefact-free breaths/infant (4770 breaths included). Oxygen saturation, heart and respiratory rates were also measured. RESULTS Ventilation was greater in the right lung (mean 69.1 (SD 14.9)%) total VT and the gravity-non-dependent (ND) lung; ideal-actual CoV 1.4 (4.5)%. The central third of the lung received the most VT, followed by the non-dependent and dependent regions (p<0.0001 repeated-measure analysis of variance). Ventilation inhomogeneity was associated with worse peripheral capillary oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (p=0.031, r2 0.12; linear regression). In those infants that later developed bronchopulmonary dysplasia (n=25), SpO2/FiO2 was worse and non-dependent ventilation inhomogeneity was greater than in those that did not (both p<0.05, t-test Welch correction). CONCLUSIONS There is high breath-by-breath variability in regional ventilation patterns during NIV in preterm infants. Ventilation favoured the ND lung, with ventilation inhomogeneity associated with worse oxygenation.
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Affiliation(s)
- Jessica Thomson
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia .,Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Christoph M Rüegger
- Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia.,Newborn Research, Department of Neonatology, University Hospital and University of Zürich, Zürich, Switzerland
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | | | - Olivia Farrell
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Louise S Owen
- Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Neonatology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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Mosing M, Waldmann AD, Sacks M, Buss P, Boesch JM, Zeiler GE, Hosgood G, Gleed RD, Miller M, Meyer LCR, Böhm SH. What hinders pulmonary gas exchange and changes distribution of ventilation in immobilized white rhinoceroses ( Ceratotherium simum) in lateral recumbency? J Appl Physiol (1985) 2020; 129:1140-1149. [PMID: 33054661 DOI: 10.1152/japplphysiol.00359.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This study used electrical impedance tomography (EIT) measurements of regional ventilation and perfusion to elucidate the reasons for severe gas exchange impairment reported in rhinoceroses during opioid-induced immobilization. EIT values were compared with standard monitoring parameters to establish a new monitoring tool for conservational immobilization and future treatment options. Six male white rhinoceroses were immobilized using etorphine, and EIT ventilation variables, venous admixture, and dead space were measured 30, 40, and 50 min after becoming recumbent in lateral position. Pulmonary perfusion mapping using impedance-enhanced EIT was performed at the end of the study period. The measured impedance (∆Z) by EIT was compared between pulmonary regions using mixed linear models. Measurements of regional ventilation and perfusion revealed a pronounced disproportional shift of ventilation and perfusion toward the nondependent lung. Overall, the dependent lung was minimally ventilated and perfused, but remained aerated with minimal detectable lung collapse. Perfusion was found primarily around the hilum of the nondependent lung and was minimal in the periphery of the nondependent and the entire dependent lung. These shifts can explain the high amount of venous admixture and physiological dead space found in this study. Breath holding redistributed ventilation toward dependent and ventral lung areas. The findings of this study reveal important pathophysiological insights into the changes in lung ventilation and perfusion during immobilization of white rhinoceroses. These novel insights might induce a search for better therapeutic options and is establishing EIT as a promising monitoring tool for large animals in the field.NEW & NOTEWORTHY Electrical impedance tomography measurements of regional ventilation and perfusion applied to etorphine-immobilized white rhinoceroses in lateral recumbency revealed a pronounced disproportional shift of the measured ventilation and perfusion toward the nondependent lung. The dependent lung was minimally ventilated and perfused, but still aerated. Perfusion was found primarily around the hilum of the nondependent lung. These shifts can explain the gas exchange impairments found in this study. Breath holding can redistribute ventilation.
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Affiliation(s)
- Martina Mosing
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Andreas D Waldmann
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Muriel Sacks
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Peter Buss
- Veterinary Wildlife Services, South African National Parks, Kruger National Park, Skukuza, South Africa
| | - Jordyn M Boesch
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Gareth E Zeiler
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa.,Centre for Veterinary Wildlife Studies and Department of Paraclinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - Giselle Hosgood
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Robin D Gleed
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Michele Miller
- Department of Science and Technology-National Research Foundation Centre of Excellence for Biomedical TB Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leith C R Meyer
- Centre for Veterinary Wildlife Studies and Department of Paraclinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - Stephan H Böhm
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
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