Evaluation of regional ventilation by electric impedance tomography during percutaneous dilatational tracheostomy in neu
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RESEARCH ARTICLE
Open Access
Evaluation of regional ventilation by electric impedance tomography during percutaneous dilatational tracheostomy in neurocritical care: a pilot study Vera Spatenkova1* , Eckhard Teschner2 and Jaroslav Jedlicka1
Abstract Background: Percutaneous dilatational tracheostomy (PDT) has become a widely performed technique in neurocritical care, which is however known to be accompanied by some risks to the patient. The aim of this pilot study was to assess the derecruitment effects of PDT with the electric impedance tomography (EIT) during the PDT procedure in neurocritical care. Methods: The prospective observational pilot study investigated 11 adult, intubated, mechanically ventilated patients with acute brain disease. We recorded EIT data to determine regional ventilation delay standard deviation (RVD SD), compliance win (CW) and loss (CL), end-expiratory lung impedance (EELI), with the EIT belt placed at the level of Th 4 before, during and after the PDT, performed in the standard PDT position ensuring hyperextension of the neck. Results: From 11 patients, we finally analyzed EIT data in 6 patients - EIT data of 5 patients have been excluded due to the insufficient EIT recordings. The mean RVD SD post-PDT decreased to 7.00 ± 1.29% from 7.33 ± 1.89%. The mean post-PDT CW was 27.33 ± 15.81 and PDT CL 6.33 ± 6.55. Only in one patient, where the trachea was open for 170 s, was a massive dorsal collapse (ΔEELI − 25%) detected. In other patients, the trachea was open from 15 to 50 s. Conclusions: This pilot study demonstrated the feasibility of EIT to detect early lung derecruitment occurring due to the PDT procedure. The ability to detect regional changes in ventilation could be helpful in predicting further progression of ventilation impairment and subsequent hypoxemia, to consider optimal ventilation regimes or timeschedule and type of recruitment maneuvres required after the PDT. Keywords: Electric impedance tomography, Neurocritical care, Percutaneous dilatational tracheostomy, Tracheostomy, Lung imaging
Background Percutaneous dilatational tracheostomy (PDT) has become a widely performed technique in neurocritical care [1–3]. However, this is a method with some risks, associated with the insertion of a tube to the trachea and * Correspondence: [email protected] 1 Neurocenter, Neurointensive Care Unit, Regional Hospital, Husova 357/10, 46063 Liberec, Czech Republic Full list of author information is available at the end of the article
derecruitment of the lung. During the opening of the trachea, the closed ventilation system is suddenly disconnected from pressurized mechanical ventilation, and the immediate and subsequent derecruitment of the lung can cause acute hypoxemia and hypercapnia. In neurocritical care, these conditions are especially threatening as they can lead to secondary brain damage and worsened outcome. Therefore, searching for methods increasing safety and reducing risks of PDT is very
© The Author(s). 2020 Open Access This article is licensed under a Creative
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