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Regional pulmonary effects of bronchoalveolar lavage procedure determined by electrical impedance tomography


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Frerichs, I, Dargaville, PA and Rimensberger, PC 2019 , 'Regional pulmonary effects of bronchoalveolar lavage procedure determined by electrical impedance tomography' , Intensive Care Medicine Experimental, vol. 7, no. 1 , pp. 1-11 , doi: 10.1186/s40635-019-0225-6.

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Background: The provision of guidance in ventilator therapy by continuous monitoring of regional lung ventilation, aeration and respiratory system mechanics is the main clinical benefit of electrical impedance tomography (EIT). A new application was recently described in critically ill patients undergoing diagnostic bronchoalveolar lavage (BAL) with the intention of using EIT to identify the region where sampling was performed. Increased electrical bioimpedance was reported after fluid instillation. To verify the accuracy of these findings, contradicting the current EIT knowledge, we have systematically analysed chest EIT data acquired under controlled experimental conditions in animals undergoing a large number of BAL procedures.Methods: One hundred thirteen BAL procedures were performed in 13 newborn piglets positioned both supine and prone. EIT data was obtained at 13 images before, during and after each BAL. The data was analysed at three time points: (1) after disconnection from the ventilator before the fluid instillation and by the ends of fluid (2) instillation and (3) recovery by suction and compared with the baseline measurements before the procedure. Functional EIT images were generated, and changes in pixel electrical bioimpedance were calculated relative to baseline. The data was examined in the whole image and in three (ventral, middle, dorsal) regions-of-interest per lung.Results: Compared with the baseline phase, chest electrical bioimpedance fell after the disconnection from the ventilator in all animals in both postures during all procedures. The fluid instillation further decreased electrical bioimpedance. During fluid recovery, electrical bioimpedance increased, but not to baseline values. All effects were highly significant (p p Conclusions: The results of this study show a regionally dissimilar initial fall in electrical bioimpedance caused by non-uniform aeration loss at the beginning of the BAL procedure. They also confirm a further pronounced fall in bioimpedance during fluid instillation, incomplete recovery after suction and a posture-dependent distribution pattern of these effects.

Item Type: Article
Authors/Creators:Frerichs, I and Dargaville, PA and Rimensberger, PC
Keywords: alveolar collapse, BAL, EIT, electrical bioimpedance, functional imaging, regional ventilation, ventilation monitoring
Journal or Publication Title: Intensive Care Medicine Experimental
Publisher: SpringerOpen
ISSN: 2197-425X
DOI / ID Number: 10.1186/s40635-019-0225-6
Copyright Information:

© The Author(s) 2019. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

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