Achieving Lung Protective Ventilation

Although respiratory care has come a long way over the years, complications attributed to inappropriate settings of mechanical ventilation continue to have an adverse impact on patient outcome. Today, lung protective ventilation strategies largely rely on physiological parameters which only reflect global lung function. The well-known complications of atelectasis and overdistension call for insight into the distribution of ventilation in the ventral and dorsal regions of the lung so that measures can be taken to individually tailor ventilator settings 1), 2), 3). CT and chest x-rays provide regionally specific information, but only as a snapshot in time. Determining how different lung regions respond to therapeutic interventions over time is challenging without continuous regional information.

1. Meier T et al., Assessment of regional lung recruitment and derecruitment during a PEEP trial based on electrical impedance tomography. Intensive Care Med 2008; 34: 543-550
2. Putensen C., Electrical impedance tomography guided ventilation therapy, Current Opinion in Critical Care 2007, 13:344–350
3. Kunst P.W. et al., Monitoring of recruitment and derecruitment by electrical impedance tomography in a model of acute lung injury. Crit Care Med 2000; 28: 3891-3895

Continuous visualization of ventilation

Dräger understands the need for continuous information about regional distribution of ventilation to be available at the bedside. Our search for a suitable solution revealed that the monitoring technique of Electrical Impedance Tomography (EIT) had the potential to address this demand.

The progress of development, and results of clinical studies, confirmed that EIT provides the required information in a superior manner 4), 5), 6).

4. Meier T. et al., Assessment of regional lung recruitment and derecruitment during a PEEP trial based on electrical impedance tomography. Intensive Care Med 2008; 34: 543-550
5. Lüpschen H. et al., Protective ventilation using electrical impedance tomography, Physiol. Meas. 28 (2007) S247–S260
6. Riedl T. et al., Regional and overall ventilation inhomogeneities in preterm and term-born infants, Intensive Care Med (2009) 35:144–151

Electrical impedance tomography

EIT monitoring involves the application of a small current and measurement of resulting voltages to determine the ventilation related impedance changes that occur in a thoracic cross-section.

Advanced data acquisition techniques and sophisticated reconstruction algorithms are used to generate tomographic images and parameters which enable the assessment of regional distribution of ventilation as well as short-term changes of end-expiratory lung volume within the cross-section. This offers clinicians a new and unique perspective on respiratory care.

PulmoVista^® 500

PulmoVista^® 500 is an Electrical Impedance Tomograph which has been specially designed for the use in clinical routine. Data is continuously displayed in the form of images, waveforms and parameters. Simply put, PulmoVista^® 500 lets you visualise the distribution of ventilation.

Supporting your everyday work

• PEEP settings
• Recruitment manoeuvres
• Tidal volume settings
• Endotracheal suctioning
• Patient positioning

Valuable real-time information

Seeing rather than assuming

PulmoVista^® 500 helps to provide a method to closely monitor the patient’s lung condition and to continuously assess the effect of respiratory treatment, thus guiding a strategy of lung protective ventilation.

Regionally specific information

Mechanical ventilation is commonly used as a life saving measure for patients with respiratory complications. However, mechanical ventilation may lead to lung injury and cause inflammatory responses. Regionally specific information helps overcome the challenge of setting PEEP and tidal volume so that the well known adverse effects of mechanical ventilation are minimized.

Continuous dynamic bedside imaging

PulmoVista^® 500 provides continuous real-time dynamic images of ventilation and intrapulmonary air distribution at the bedside. Monitoring is possible for up to 24 hours, enabling a close watch to be kept on critical lung conditions and the effect of therapy changes.

Non-invasive monitoring

The regional ventilation monitoring provided by PulmoVista^® 500 is non-invasive and without any side-effects. Unlike chest x-rays or CT, there’s no ionising radiation involved. Patient preparation only requires the positioning of a flexible non-adhesive belt around the patient’s chest. PulmoVista^® 500 has been designed with the busy ICU environment in mind and does not interfere with the ICU workflow.

7. Erlandson K. et al., Positive end-expiratory pressure optimization using electric impedance tomography in morbidly obese patients during laparoscopic gastric bypass surgery, Acta Anaesthesiol Scand 2006; 50: 833–839
8. Lindgren S. et al., Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography, Intensive Care Med (2007) 33:172–180
9. Odenstedt H. et al., Slow moderate pressure recruitment manoeuvres minimizes negative circulatory and lung mechanic side effects: evaluation of recruitment manoeuvres using electric impedance tomography, Intensive Care Med (2005) 31:1706–1714