The predictive value of transthoracic electrical impedance tomography in weaning the adult patients from mechanical ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Meiling ¹ , DING Yuru ² , PENG Liangshan ¹ , LUO Qiong ¹ ,  WANG Qiaosheng ¹

1. Department of Critical Care Medicine, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, P. R. China;
2. Department of Critical Care Medicine, The First People’s Hospital of Tianshui, Tianshui, Gansu 741000, P. R. China;

Corresponding author：

WANG Qiaosheng, Email: docwqs@163.com

Keywords：

Electrical impedance tomography; mechanical ventilation; weaning; predictive value

DOI：

10.7507/1671-6205.202411003

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Objective To explore the predictive value of transthoracic electrical impedance tomography (EIT) for outcome of weaning patients from mechanical ventilation. Methods Forty invasive mechanical ventilation adult patients who underwent spontaneous breathing test (SBT) from May 2022 to August 2022 were enrolled. The patients were divided into a successful weaning group (n=28) and a failed weaning group (n=12) based on whether invasive mechanical ventilation was required within 48 hours after weaning. EIT data were collected from both groups on the first day of mechanical ventilation, before SBT, 10 minutes after SBT, and 30 minutes after SBT. The EIT parameters were compared between two groups, including the absolute value of mean end expiratory lung impedance variation (Mean △EELI) to tidal volume ratio, percentage variation of local compliance change (|Δ(CW-CL)|), inflation time difference (TSA), standard deviation of regional ventilation delay (SDRVD), abdominal to back impedance ratio (IR), and rapid shallow breathing index (RSBI) calculated by EIT, at different time points of SBT, and the predictive value of each EIT parameter were evaluated for weaning. Results The parameters of SDRVD value, RSBI_EIT value, and TSA value in the successful weaning group were significantly lower compared with the failed weaning group (P<0.05); during SBT process, the predictive value of the SDRVD for weaning was the highest compared with other EIT parameters (AUC=0.978, 95%CI 0.940-1.016; P<0.001). When the SDRVD value, less than 0.845, was as the critical value and the sensitivity was 0.917 and the specificity was 0.929; the RSBI_EIT value for prediction weaning also was high (AUC=0.960, 95%CI 0.904-1.015; P<0.001). When RSBI_EIT, less than 0.893, was used as the critical value, and its sensitivity and specificity was 1.000 and 0.893, respectively (P<0.05). The TSA value and |Δ(CW-CL)| predicted weaning value are relatively small, and further research is needed on whether IR and |Mean ∆EELI/VT| can guide weaning. Conclusions The EIT parameters SDRVD and RSBI_EIT can effectively predict the weaning outcomes of mechanically ventilated adult patients and have good clinical application value.

1.	Esteban A, Frutos-Vivar F, Muriel A, et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med, 2013, 188(2): 220-230.
2.	Mayo P, Volpicelli G, Lerolle N, et al. Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung. Intensive Care Med, 2016, 42(7): 1107-1117.
3.	Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med, 1991, 324(21): 1445-1450.
4.	El-Khatib MF, Zeineldine SM, Jamaleddine GW. Effect of pressure support ventilation and positive end expiratory pressure on the rapid shallow breathing index in intensive care unit patients. Intensive Care Med, 2008, 34(3): 505-510.
5.	Reis AMD, Midega TD, Deliberato RO, et al. Effect of spontaneous breathing on ventilator-free days in critically ill patients-an analysis of patients in a large observational cohort. Ann Transl Med, 2021, 9(9): 783.
6.	Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J, 2007, 29(5): 1033-1056.
7.	Thille AW, Harrois A, Schortgen F, et al. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med, 2011, 39: 2612-2618.
8.	Peñuelas Ó, Thille AW, Esteban A. Discontinuation of ventilatory support: new solutions to old dilemmas. Curr Opin Crit Care, 2015, 21(1): 74-81.
9.	Costa EL, Lima RG, Amato MB. Electrical impedance tomography. Curr Opin Crit Care, 2009, 15(1): 18-24.
10.	Henderson RP, Webster JG. An impedance camera for spatially specific measurements of the thorax. IEEE Trans Biomed Eng, 1978, 25(3): 250-254.
11.	Wisse JJ, Goos TG, Jonkman AH, et al. Electrical impedance tomography as a monitoring tool during weaning from mechanical ventilation: an observational study during the spontaneous breathing trial. Respir Res, 2024, 25(1): 179.
12.	Zhao Z, Peng SY, Chang MY, et al. Spontaneous breathing trials after prolonged mechanical ventilation monitored by electrical impedance tomography: an observational study. Acta Anaesthesiol Scand, 2017, 61(9): 1166-1175.
13.	Mauri T, Eronia N, Abbruzzese C, et al. Effects of sigh on regional lung strain and ventilation heterogeneity in acute respiratory failure patients undergoing assisted mechanical ventilation. Crit Care Med, 2015, 43(9): 1823-1831.
14.	Muders T, Luepschen H, Zinserling J, et al. Tidal recruitment assessed by electrical impedance tomography and computed tomography in a porcine model of lung injury. Crit Care Med, 2012, 40(3): 903-911.
15.	Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med, 2006, 144(8): 596-608.
16.	Bickenbach J, Czaplik M, Polier M, et al. Electrical impedance tomography for predicting failure of spontaneous breathing trials in patients with prolonged weaning. Crit Care, 2017, 21(1): 177.
17.	Gayen S, van der Rijst N, D'Alonzo G, et al. Unexpected pulmonary mechanics during positive pressure mechanical ventilation in fibrotic lung disease with concomitant flail chest. Respir Med Case Rep, 2023, 41: 101802.
18.	Okabe Y, Asaga T, Bekku S, et al. Lung-thorax compliance measured during a spontaneous breathing trial is a good index of extubation failure in the surgical intensive care unit: a retrospective cohort study. J Intensive Care, 2018, 6: 44.
19.	沈继龙, 王琛, 王元元, 等. 电阻抗断层显像技术在急性呼吸窘迫综合征患者设定呼气末正压中的临床应用. 中国呼吸与危重监护杂志, 2023, 22(1): 32-37.
20.	Battaglini D, Robba C, Ball L, et al. Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review. Br J Anaesth, 2021, 127(3): 353-364.
21.	Muders T, Luepschen H, Putensen C. Impedance tomography as a new monitoring technique. Curr Opin Crit Care, 2010, 16(3): 269-275.
22.	Forgiarini LAJ, Esquinas AM. The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data. J Bras Pneumol, 2016, 42(4): 306.
23.	Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure--a structured approach. Crit Car, 2010;14(6): 245.
24.	Reardon PM, Wong J, Fitzpatrick A, et al. Diaphragm function in acute respiratory failure and the potential role of phrenic nerve stimulation. Curr Opin Crit Care, 2021, 27(3): 282-289.
25.	赵永华, 靳立振, 于巧青, 等. 脱机试验时应用膈肌浅快呼吸指数预测脱机的临床研究. 中国呼吸与危重监护杂志, 2021, 20(2): 118-122.

1. Esteban A, Frutos-Vivar F, Muriel A, et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med, 2013, 188(2): 220-230.
2. Mayo P, Volpicelli G, Lerolle N, et al. Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung. Intensive Care Med, 2016, 42(7): 1107-1117.
3. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med, 1991, 324(21): 1445-1450.
4. El-Khatib MF, Zeineldine SM, Jamaleddine GW. Effect of pressure support ventilation and positive end expiratory pressure on the rapid shallow breathing index in intensive care unit patients. Intensive Care Med, 2008, 34(3): 505-510.
5. Reis AMD, Midega TD, Deliberato RO, et al. Effect of spontaneous breathing on ventilator-free days in critically ill patients-an analysis of patients in a large observational cohort. Ann Transl Med, 2021, 9(9): 783.
6. Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J, 2007, 29(5): 1033-1056.
7. Thille AW, Harrois A, Schortgen F, et al. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med, 2011, 39: 2612-2618.
8. Peñuelas Ó, Thille AW, Esteban A. Discontinuation of ventilatory support: new solutions to old dilemmas. Curr Opin Crit Care, 2015, 21(1): 74-81.
9. Costa EL, Lima RG, Amato MB. Electrical impedance tomography. Curr Opin Crit Care, 2009, 15(1): 18-24.
10. Henderson RP, Webster JG. An impedance camera for spatially specific measurements of the thorax. IEEE Trans Biomed Eng, 1978, 25(3): 250-254.
11. Wisse JJ, Goos TG, Jonkman AH, et al. Electrical impedance tomography as a monitoring tool during weaning from mechanical ventilation: an observational study during the spontaneous breathing trial. Respir Res, 2024, 25(1): 179.
12. Zhao Z, Peng SY, Chang MY, et al. Spontaneous breathing trials after prolonged mechanical ventilation monitored by electrical impedance tomography: an observational study. Acta Anaesthesiol Scand, 2017, 61(9): 1166-1175.
13. Mauri T, Eronia N, Abbruzzese C, et al. Effects of sigh on regional lung strain and ventilation heterogeneity in acute respiratory failure patients undergoing assisted mechanical ventilation. Crit Care Med, 2015, 43(9): 1823-1831.
14. Muders T, Luepschen H, Zinserling J, et al. Tidal recruitment assessed by electrical impedance tomography and computed tomography in a porcine model of lung injury. Crit Care Med, 2012, 40(3): 903-911.
15. Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med, 2006, 144(8): 596-608.
16. Bickenbach J, Czaplik M, Polier M, et al. Electrical impedance tomography for predicting failure of spontaneous breathing trials in patients with prolonged weaning. Crit Care, 2017, 21(1): 177.
17. Gayen S, van der Rijst N, D'Alonzo G, et al. Unexpected pulmonary mechanics during positive pressure mechanical ventilation in fibrotic lung disease with concomitant flail chest. Respir Med Case Rep, 2023, 41: 101802.
18. Okabe Y, Asaga T, Bekku S, et al. Lung-thorax compliance measured during a spontaneous breathing trial is a good index of extubation failure in the surgical intensive care unit: a retrospective cohort study. J Intensive Care, 2018, 6: 44.
19. 沈继龙, 王琛, 王元元, 等. 电阻抗断层显像技术在急性呼吸窘迫综合征患者设定呼气末正压中的临床应用. 中国呼吸与危重监护杂志, 2023, 22(1): 32-37.
20. Battaglini D, Robba C, Ball L, et al. Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review. Br J Anaesth, 2021, 127(3): 353-364.
21. Muders T, Luepschen H, Putensen C. Impedance tomography as a new monitoring technique. Curr Opin Crit Care, 2010, 16(3): 269-275.
22. Forgiarini LAJ, Esquinas AM. The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data. J Bras Pneumol, 2016, 42(4): 306.
23. Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure--a structured approach. Crit Car, 2010;14(6): 245.
24. Reardon PM, Wong J, Fitzpatrick A, et al. Diaphragm function in acute respiratory failure and the potential role of phrenic nerve stimulation. Curr Opin Crit Care, 2021, 27(3): 282-289.
25. 赵永华, 靳立振, 于巧青, 等. 脱机试验时应用膈肌浅快呼吸指数预测脱机的临床研究. 中国呼吸与危重监护杂志, 2021, 20(2): 118-122.

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