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Journal of Clinical Monitoring and Computing

17.05.2024 | Original Research

Dynamic inflation prevents and standardized lung recruitment reverts volume loss associated with percutaneous tracheostomy during volume control ventilation: results from a Neuro-ICU population

verfasst von: Luca Bastia, Roberta Garberi, Lorenzo Querci, Cristiana Cipolla, Francesco Curto, Emanuele Rezoagli, Roberto Fumagalli, Arturo Chieregato

Erschienen in: Journal of Clinical Monitoring and Computing

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Abstract

To determine how percutaneous tracheostomy (PT) impacts on respiratory system compliance (C_rs) and end-expiratory lung volume (EELV) during volume control ventilation and to test whether a recruitment maneuver (RM) at the end of PT may reverse lung derecruitment. This is a single center, prospective, applied physiology study. 25 patients with acute brain injury who underwent PT were studied. Patients were ventilated in volume control ventilation. Electrical impedance tomography (EIT) monitoring and respiratory mechanics measurements were performed in three steps: (a) baseline, (b) after PT, and (c) after a standardized RM (10 sighs of 30 cmH₂O lasting 3 s each within 1 min). End-expiratory lung impedance (EELI) was used as a surrogate of EELV. PT determined a significant EELI loss (mean reduction of 432 arbitrary units p = 0.049) leading to a reduction in C_rs (55 ± 13 vs. 62 ± 13 mL/cmH₂O; p < 0.001) as compared to baseline. RM was able to revert EELI loss and restore C_rs (68 ± 15 vs. 55 ± 13 mL/cmH₂O; p < 0.001). In a subgroup of patients (N = 8, 31%), we observed a gradual but progressive increase in EELI. In this subgroup, patients did not experience a decrease of C_rs after PT as compared to patients without dynamic inflation. Dynamic inflation did not cause hemodynamic impairment nor raising of intracranial pressure. We propose a novel and explorative hyperinflation risk index (HRI) formula. Volume control ventilation did not prevent the PT-induced lung derecruitment. RM could restore the baseline lung volume and mechanics. Dynamic inflation is common during PT, it can be monitored real-time by EIT and anticipated by HRI. The presence of dynamic inflation during PT may prevent lung derecruitment.

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Titel: Dynamic inflation prevents and standardized lung recruitment reverts volume loss associated with percutaneous tracheostomy during volume control ventilation: results from a Neuro-ICU population
verfasst von: Luca Bastia
Roberta Garberi
Lorenzo Querci
Cristiana Cipolla
Francesco Curto
Emanuele Rezoagli
Roberto Fumagalli
Arturo Chieregato
Publikationsdatum: 17.05.2024
Verlag: Springer Netherlands
Erschienen in: Journal of Clinical Monitoring and Computing
Print ISSN: 1387-1307
Elektronische ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-024-01174-x

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Dynamic inflation prevents and standardized lung recruitment reverts volume loss associated with percutaneous tracheostomy during volume control ventilation: results from a Neuro-ICU population

Abstract

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Blutdrucksenkung schon im Rettungswagen bei akutem Schlaganfall?

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Abstract

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Neu im Fachgebiet AINS

Mit dem Seitenschneider gegen das Reißverschluss-Malheur

Blutdrucksenkung schon im Rettungswagen bei akutem Schlaganfall?

Ähnliche Überlebensraten nach Reanimation während des Transports bzw. vor Ort

Nicht Creutzfeldt Jakob, sondern Abführtee-Vergiftung

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