Thesis supervisor: András Lovas
Location of studies (in Hungarian): SZTE ÁOK AITI Abbreviation of location of studies: AITI
Description of the research topic:
Diagnosis and treatment of the hypoxic respiratory failure induced by severe atelectasis with the background of acute lung injury is challenging for the intensive care physicians [1]. Mechanical ventilation commenced with grave hypoxemia is one of the most common organ support therapies applied in the critically ill. However, respiratory therapy can improve gas exchange until the elimination of the damaging pathomechanism and the regeneration of the lung tissue, mechanical ventilation is a double edge sword. Mechanical ventilation induced volu- and barotrauma with the cyclic shearing forces can evoke further lung injury on its own [2].
Computer tomography (CT) of the chest is still the gold standard in the diagnostic protocols of the hypoxemic respiratory failure [3]. However, CT can reveal scans not just about the whole bilateral lung parenchima but also about the mediastinal organs, it requires the transportation of the critically ill and exposes the patient to extra radiation. At the same time the reproducibility of the CT is poor and it offers just a snapshot about the ongoing progression of the disease. On the contrary electric impedance tomography (EIT) provides a real time, dynamic and easily reproducible information about one lung segment at the bed side [4]. At the same time these picture imaging techniques are supplemented by the pressure parameters and lung mechanical properties assigned and displayed by the ventilator. The latter can be ameliorated by the measurement of the intrapleural pressure. Through with this extra information transpulmonary pressure can be estimated what directly effects the alveoli [5].
Unfortunately, parameters measured by the respirator provide only a global status about the state of the lungs. On the contrary acute lung injury is characterized by focal injuries of the lung parenchima where undamaged alveoli take part in the gas exchange next to the impaired ones [3]. EIT can aim the identification of these lesions by the assessment of the focal mechanical properties when parameters measured by the ventilator are also involved. The latter one can not just take a role in the diagnosis but with the support of it the effectivity of the alveolar recruitment can be estimated and optimal ventilator parameters can be determined preventing further damage caused by the mechanical stress [6].
However, preserved spontaneous breathing with assisted ventilation of the hypoxemic patient provides many advantages there is lack of distinct data about the grade of injury caused by the active respiration. Beyond there is deficient information about the required level of pressure needed for an adequate alveolar recruitment under supported ventilation together with the degree of the haemodynamic effects induced by the permanently increased transpulmonary pressure [7].
REFERENCES
1. Chiumello D, Brochard L, Marini JJ et al. Respiratory support in patients with acute respiratory distress syndrome: an expert opinion. Crit Care. 2017;21(1):240
2. Marini JJ. Evolving concepts for safer ventilation. Crit Care. 2019;23(Suppl 1):114
3. Pesenti A, Musch G, Lichtenstein D et al. Imaging in acute respiratory distress syndrome. Intensive Care Med. 2016;42(5):686-698
4. Frerichs I, Amato MBP, van Kaam AH et al. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax. 2017;72(1):83-93
5. Yoshida T, Borchard L. Esophageal pressure monitoring: why, when and how? Curr Opin Crit Care. 2018;24(3):216-222
6. Costa EL, Borges JB, Melo A, et al. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography. Intensive Care Med 2009;35:1132–1137.
7. Lovas A., Szakmány T. Haemodynamic effects of lung recruitment manoeuvres. Biomed Res Int. 2015; 2015: 478970.
Required language skills: English B2 Further requirements: research work
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