Omics approach to chest electrical impedance tomography reveals physiological cluster of ARDS characterised by increased respiratory drive and effort.

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Tommaso Mauri, Marco Leali, Elena Spinelli, Gaetano Scaramuzzo, Massimo Antonelli, Domenico L Grieco, Savino Spadaro, Giacomo Grasselli
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引用次数: 0

Abstract

Background: Non-invasive assessment of respiratory drive and effort in spontaneously breathing ARDS patients is challenging, yet clinically relevant. We explored whether hierarchical clustering applied to electrical impedance tomography (EIT- a radiation-free non-invasive lung imaging technique) identifies ARDS sub-phenotypes with increased drive and effort.

Results: Thirty intubated patients with ARDS on assisted mechanical ventilation were monitored by EIT and esophageal pressure during a decremental positive end-expiratory pressure (PEEP) trial. A comprehensive EIT assessment was made (computed variables n = 180) during tidal breathing at different PEEP levels. Agglomerative nesting was applied to scaled data distances. Three clusters of ARDS were identified: inhomogeneous ventilation, unmatched V'/Q, and mismatched V'/Q. The unmatched V'/Q cluster had the highest respiratory drive (p = 0.045) and effort (p = 0.021) at lower PEEP, and experienced longer length of ICU stay (p = 0.019).

Conclusions: Higher PEEP levels reduced drive of the unmatched V'/Q cluster, mitigating the physiological differences. Clustering approaches to EIT data identify physiologically and clinically relevant sub-phenotypes of ARDS.

组学方法胸部电阻抗断层扫描显示以呼吸驱动和努力增加为特征的ARDS生理集群。
背景:无创评估自发性呼吸ARDS患者的呼吸动力和努力具有挑战性,但具有临床意义。我们探讨了是否将分层聚类应用于电阻抗断层扫描(EIT-一种无辐射无创肺成像技术)识别ARDS亚表型需要增加驱动和努力。结果:30例辅助机械通气气管插管ARDS患者在呼气末正压递减(PEEP)试验中采用EIT和食管压监测。对不同PEEP水平的潮汐呼吸进行综合EIT评估(计算变量n = 180)。凝聚嵌套应用于缩放数据距离。ARDS分为三组:通气不均匀、V′/Q不匹配和V′/Q不匹配。不匹配的V′/Q组在低PEEP时呼吸驱动(p = 0.045)和用力(p = 0.021)最高,且ICU住院时间较长(p = 0.019)。结论:较高的PEEP水平降低了不匹配的V′/Q簇驱动,减轻了生理差异。EIT数据的聚类方法确定了ARDS的生理和临床相关亚表型。
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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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