Application effect of pulmonary electric impedance tomography-guided positive end-expiratory pressure on mechanical ventilation in patients with traumatic brain injury complicated with acute respiratory distress syndrome
Objective To compare the application effects of electric impedance tomography(EIT)-guided positive end-expiratory pressure conventional PEEP and PEEP-fraction of inspired oxygen(FiO2)table-guided PEEP in the mechanical ventilation of patients with traumatic brain injury(TBI)complicated with acute respiratory distress syndrome(ARDS).Methods A retrospective cohort study was conducted on the clinical data of 80 TBI patients complicated with ARDS admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from July 2020 to December 2022,including 42 males and 38 females,aged 29-59 years[(42.4±7.8)years].The Glasgow coma scale(GCS)scores were 3-12 points[(7.7±2.2)points].According to ARDS classification,33 were mild,26 moderate and 21 severe.All the patients were treated with mechanical ventilation according to lung protective ventilation strategy,including 42 patients treated with EIT-guided PEEP(EIT group)and 38 treated with conventional PEEP-FiO2 table-guided PEEP(conventional group).At 12 hours,1,3 and 5 days after ventilation,the optimal PEEP,respiratory mechanics[driving pressure(△P),static compliance(CSt),mechanical power(MP)],pulmonary gas exchange[arterial blood pH value,arterial partial pressure of carbon dioxide(PaCO2),oxygenation index(P/F)],ventilation distribution[heterogeneity index(GI),regions of interest(ROI)1-4],hemodynamics[heart rate(HR),central venous pressure(CVP),mean arterial pressure(MAP)],cerebral perfusion status[intracranial pressure(ICP),regional cerebral oxygen saturation(rScO2)grading],and treatment outcomes(mechanical ventilation duration,incidence of ventilator-induced lung injury(VILI),length of ICU stay,6-month survival rate)separately at their optimal PEEP were compared between the two groups.Results All the patients were followed up for 6 months.The optimal PEEP of the EIT group was(7.4±1.0)cm,(8.2±1.2)cm,(9.8±0.8)cm and(8.4±0.7)cm respectively at 12 hours,1,3 and 5 days after mechanical ventilation,which were higher than(7.0±1.0)cm,(7.6±1.0)cm,(9.0±0.6)cm and(7.2±0.5)cm of the conventional group(P＜0.05 or 0.01).At their optimal PEEP separately,at 12 hours,1,3 and 5 days after treatment,the △P of the EIT group was(7.1±1.3)cmH2O,(7.7±1.3)cmH2O,(9.5±1.1)cmH2O and(6.1±1.3)cmH2O respectively,which were all lower than(8.9±1.3)cmH2O,(10.5±1.3)cmH2O,(11.2±1.2)cmH2O and(8.7±1.2)cmH2O of the conventional group respectively(P＜0.05 or 0.01);the CSt of the EIT group was(51.5±4.2)ml/cmH2O,(52.9±4.6)ml/cmH2O,(55.1±4.3)ml/cmH2O and(57.5±3.6)ml/cmH2O,which were all higher than(46.8± 3.9)ml/cmH2O,(47.6±4.4)ml/cmH2O,(49.9±4.3)ml/cmH2O and(53.3±3.6)ml/cmH2O of the conventional group respectively(P＜0.05);the MP of the EIT group was(7.9±1.8)J/min,(8.8±1.3)J/min,(10.6±1.3)J/min and(7.8±0.9)J/min,which were lower than(8.6±1.5)J/min,(9.5±1.0)J/min,(12.2±1.8)J/min and(8.6± 0.9)J/min of the conventional group respectively(P＜0.05 or 0.01);the P/F of the EIT group was(207.1± 7.1)mmHg,(213.1±6.9)mmHg,(239.3±13.1)mmHg and(255.5±11.8)mmHg,which were all higher than(179.6±7.2)mmHg,(187.8±9.6)mmHg,(212.8±9.6)mmHg and(228.1±12.3)mmHg of the conventional group respectively(P＜0.05 or 0.01);the GI of the EIT group were 0.381±0.013,0.387±0.012,0.392± 0.010 and 0.395±0.010,lower than 0.403±0.005,0.406±0.005,0.409±0.005 and 0.411±0.004 of traditional group respectively(P＜0.01);there were no significant differences in the arterial blood pH value,PaCO2,ROI1-4,HR,CVP,MAP,ICP,or rScO2 grading between the two groups(P＞0.05).The ventilation duration of the EIT group was(78.5±9.0)hours,which was shorter than(83.1±7.4)hours of the conventional group(P＜0.05).The incidence of VILI was 0.0％(0/42)in the EIT group,which was lower than 7.8％(3/38)in the conventional group(P＜0.05).There were no significant differences in the ICU stay or 6-month survival rate between the two groups(P＞0.05).Conclusions In mechanical ventilation treatment of TBI complicated with ARDS,the optimal PEEP guided by EIT was higher than that guided by PEEP-FiO2 table.At this optimal PEEP,the respiratory mechanics and oxygen supply of the patients can be improved more effectively,making regional lung ventilation more uniform,reducing the mechanical ventilation time and decreasing the incidence of VILI without affecting their hemodynamics and brain perfusion.
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