ELECTRICAL IMPEDANCE TOMOGRAPHY OF THE LUNGS IN THE PRACTICE OF THE ANESTHESIOLOGIST.

Abstract

The aim: To assess validity of EITL for mechanical ventilation optimization during GA.

Materials: 26 cardiac surgery patients participated in non-randomized comparative study. Everyone was ventilated with protective regimen: Vt - 6-8 ml/kg, breath rate - by normal EtCO2, i/e - 1.1,5. PEEP setting in group A (n = 15) was based on EITL data, in group B (n = 11, controls) - on the discretion of the anesthesiologist. We compared PEEP peak airway pressure (PAP), dynamic compliance, SpO2 and postoperative pulmonary complications. Bronchoscopy (FTBS) was performed after the onset of mechanical ventilation in 15 patients.

Results: Mask ventilation contributed redistribution of ventilation to ventral regions in 88,4% ofpatients. Ventilation by the end of surgery was remained un-changed more often in gr A than in gr B (86,6% vs. 36,6%, p = 0,026). PAP was higher in gr B by the end of surgery (19?1,4 vs. 17,3±2,2 cm H20; p = 0,03). Compliance by the end of surgery was not reduced below baseline's more frequently in gr A (73,3% in gr A vs. 27,2% in gr B, p = 0,053). After FTBS, ventilation after of mechanical ventilation renewal was comparable with baseline ' in 80%, deteriorated in 13,3% and improved in 6,6% ofpatients.

Conclusions: 1) EITL is a convenient toolfor ventilation dynamic evaluation during anesthesia; 2) EITL advances the mask ventilation, allows to set up appropriate PEEP during anesthesia and to evaluate safety of the disconnection during FTBS; 3) EITL contributes to professional education of anesthesiologists.