Thoracic electrical impedance tomographic measurements during volume controlled ventilation-effects of tidal volume and positive end-expiratory pressure

The aim of the study was to analyze thoracic electrical impedance tomographic (EIT) measurements accomplished under conditions comparable with clinical situations during artificial ventilation. Multiple EIT measurements were performed in pigs in three transverse thoracic planes during the volume controlled mode of mechanical ventilation at various tidal volumes (V(T)) and positive end-expiratory pressures (PEEP). The protocol comprised following ventilatory patterns: 1) V(T)(400, 500, 600, 700 ml) was varied in a random order at various constant PEEP levels and 2) PEEP (2, 5, 8, 11, 14 cm H2O) was randomly modified during ventilation with a constant V(T). The EIT technique was used to generate cross-sectional images of 1) regional lung ventilation and 2) regional shifts in lung volume with PEEP. The quantitative analysis was performed in terms of the tidal amplitude of the impedance change, reflecting the volume of delivered gas at various preset V(T) and the end-expiratory impedance change, revealing the variation of the lung volume at various PEEP levels. The results showed: 1) an increase in the tidal amplitude of the impedance change, proportional to the delivered V(T) at all constant PEEP levels, 2) a rising end-expiratory impedance change, with PEEP reflecting an increase in gas volume, and 3) a PEEP-dependent redistribution of the ventilated gas between the planes. The generated images and the quantitative results indicate the ability of EIT to identify regional changes in V(T) and lung volume during mechanical ventilation.