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Personalisation of Therapies in COVID-19 Associated Acute Respiratory Distress Syndrome, Using Electrical Impedance Tomography

Atsuko Shono

Atsuko Shono

Department of Intensive Care Medicine, Showa University School of Medicine, ShinagawaTokyo, Japan
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Shono, Atsuko
, 
Toru Kotani

Toru Kotani

Department of Intensive Care Medicine, Showa University School of Medicine, ShinagawaTokyo, Japan
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Kotani, Toru
 and 
Inéz Frerichs

Inéz Frerichs

Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Schleswig-HolsteinCampus Kiel, Germany
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Frerichs, Inéz
  
Jan 29, 2021
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Article Category: Case Report
Published Online: Jan 29, 2021
Page range: 62 - 66
Received: Jul 19, 2020
Accepted: Nov 24, 2020
DOI: https://doi.org/10.2478/jccm-2020-0045
Keywords
© 2021 Atsuko Shono, Toru Kotani, Inéz Frerichs, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1

A Global EIT signal waveform in arbitrary units (AU) acquired in a supine patient suffering from COVID-19 related ARDS during two incremental and four decremental steps in positive end-expiratory pressure (PEEP) (top). The blue arrows show the amplitude of tidal impedance variation (TIV) during ventilation at the initial PEEP value and the change in end-expiratory lung impedance at the last PEEP value compared to the beginning of the manoeuvre. The numbers above the waveform present the set PEEP values in cmH2O. Regional Δ end-expiratory lung impedance in ventral and dorsal lung regions relative to the initial values at the lowest PEEP (bottom left) demonstrate the more pronounced increase in the dependent regions, implying recruitment. Chest CT scan (bottom right) was obtained on Day 1 of ICU admission.
A Global EIT signal waveform in arbitrary units (AU) acquired in a supine patient suffering from COVID-19 related ARDS during two incremental and four decremental steps in positive end-expiratory pressure (PEEP) (top). The blue arrows show the amplitude of tidal impedance variation (TIV) during ventilation at the initial PEEP value and the change in end-expiratory lung impedance at the last PEEP value compared to the beginning of the manoeuvre. The numbers above the waveform present the set PEEP values in cmH2O. Regional Δ end-expiratory lung impedance in ventral and dorsal lung regions relative to the initial values at the lowest PEEP (bottom left) demonstrate the more pronounced increase in the dependent regions, implying recruitment. Chest CT scan (bottom right) was obtained on Day 1 of ICU admission.

Fig. 2

The figure shows the analysis of regional lung ventilation in a supine patient with COVID-19 related ARDS using EIT, carried out during two incremental and four decremental steps in positive end-expiratory pressure (PEEP). Functional EIT images of regional tidal impedance variation (TIV) (top) show the distribution of tidal volume in the chest cross-section. Ventilated areas are presented in white and blue colors, the numbers below the images give the global sums of TIV values in percent of initial value at PEEP of 10 cmH2O. Functional EIT images of regional changes in TIV (ΔTIV) (middle) highlight the local increases (light blue areas) and decreases (orange areas) in ventilation at individual PEEP values in comparison with the initial lowest PEEP. The numbers below the images specify the relative changes in TIV in ventral and dorsal lung regions in comparison with the initial TIV distribution at the start of the manoeuvre. Ventilation profiles (bottom) show the distribution of ventilation in the right and left lung regions along the ventrodorsal chest diameter. White horizontal lines in each profile indicate the location of the centre of ventilation (CoV) with the corresponding values plotted below each profile. Values smaller than 50% imply preferential ventilation distribution towards ventral regions.
The figure shows the analysis of regional lung ventilation in a supine patient with COVID-19 related ARDS using EIT, carried out during two incremental and four decremental steps in positive end-expiratory pressure (PEEP). Functional EIT images of regional tidal impedance variation (TIV) (top) show the distribution of tidal volume in the chest cross-section. Ventilated areas are presented in white and blue colors, the numbers below the images give the global sums of TIV values in percent of initial value at PEEP of 10 cmH2O. Functional EIT images of regional changes in TIV (ΔTIV) (middle) highlight the local increases (light blue areas) and decreases (orange areas) in ventilation at individual PEEP values in comparison with the initial lowest PEEP. The numbers below the images specify the relative changes in TIV in ventral and dorsal lung regions in comparison with the initial TIV distribution at the start of the manoeuvre. Ventilation profiles (bottom) show the distribution of ventilation in the right and left lung regions along the ventrodorsal chest diameter. White horizontal lines in each profile indicate the location of the centre of ventilation (CoV) with the corresponding values plotted below each profile. Values smaller than 50% imply preferential ventilation distribution towards ventral regions.
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English
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4 times per year
Journal Subjects:
Medicine, Clinical Medicine, Internal Medicine, Internal Medicine, other, Surgery, Surgery, other, Anaesthesiology, Emergency Medicine and Intensive-Care Medicine
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