Juliette E Francovich, Peter Somhorst, Diederik Gommers, Henrik Endeman, Annemijn H Jonkman
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引用次数: 0
摘要
目的:
在电阻抗断层成像(EIT)监测中选择感兴趣区(ROI)的几何方法可能对通气分布的细微变化缺乏敏感性。因此,我们展示了一种定义 ROI 的新生理方法。这与使用 ROI 计算后续 EIT 参数(如呼气末正压(PEEP)试验过程中的腹背比)相关。为了证明我们的新方法的效果,我们对 49 名接受机械通气的 ICU 患者进行了递减 PEEP 试验期间的 EIT 测量。我们比较了通气中心(CoV)与我们的生理 ROI 选择方法和不同的常用 ROI 选择方法,前者是通气背侧分布变化的可靠参数。此外,我们还确定了不同 ROI 选择方法对腹背比例最接近 1 时 PEEP 水平的影响。主要结果:
与几何 ROI 定义相比,我们新的生理 ROI 选择方法中腹背 ROI 的分界线更接近 CoV。此外,腹背比为 1 时的 PEEP 水平受所选 ROI 选择方法的影响很大,这可能会对临床产生深远影响;根据所选 ROI 选择方法的不同,PEEP 水平的受试者范围为 6.2 cmH2O。
意义:
我们用于 ROI 定义的新型生理学方法对机械通气过程中通气引起的区域阻抗的微妙变化(即由于(去)募集)非常敏感,与 CoV 相似。
Physiological definition for region of interest selection in electrical impedance tomography data: description and validation of a novel method.
Objective. Geometrical region of interest (ROI) selection in electrical impedance tomography (EIT) monitoring may lack sensitivity to subtle changes in ventilation distribution. Therefore, we demonstrate a new physiological method for ROI definition. This is relevant when using ROIs to compute subsequent EIT-parameters, such as the ventral-to-dorsal ratio during a positive end-expiratory pressure (PEEP) trial.Approach.Our physiological approach divides an EIT image to ensure exactly 50% tidal impedance variation in the ventral and dorsal region. To demonstrate the effects of our new method, EIT measurements during a decremental PEEP trial in 49 mechanically ventilated ICU-patients were used. We compared the center of ventilation (CoV), a robust parameter for changes in ventro-dorsal ventilation distribution, to our physiological ROI selection method and different commonly used ROI selection methods. Moreover, we determined the impact of different ROI selection methods on the PEEP level corresponding to a ventral-to-dorsal ratio closest to 1.Main results.The division line separating the ventral and dorsal ROI was closer to the CoV for our new physiological method for ROI selection compared to geometrical ROI definition. Moreover, the PEEP level corresponding to a ventral-to-dorsal ratio of 1 is strongly influenced by the chosen ROI selection method, which could have a profound clinical impact; the within-subject range of PEEP level was 6.2 cmH2O depending on the chosen ROI selection method.Significance.Our novel physiological method for ROI definition is sensitive to subtle ventilation-induced changes in regional impedance (i.e. due to (de)recruitment) during mechanical ventilation, similar to the CoV.
期刊介绍:
Physiological Measurement publishes papers about the quantitative assessment and visualization of physiological function in clinical research and practice, with an emphasis on the development of new methods of measurement and their validation.
Papers are published on topics including:
applied physiology in illness and health
electrical bioimpedance, optical and acoustic measurement techniques
advanced methods of time series and other data analysis
biomedical and clinical engineering
in-patient and ambulatory monitoring
point-of-care technologies
novel clinical measurements of cardiovascular, neurological, and musculoskeletal systems.
measurements in molecular, cellular and organ physiology and electrophysiology
physiological modeling and simulation
novel biomedical sensors, instruments, devices and systems
measurement standards and guidelines.