Skin-to-skin care alters regional ventilation in stable neonates

ObjectiveSkin-to-skin care (SSC) has proven psychological benefits; however, the physiological effects are less clearly defined. Regional ventilation patterns during SSC have not previously been reported. This study aimed to compare regional ventilation indices and other cardiorespiratory parameters during prone SSC with supine and prone position cot-nursing.DesignProspective observational study.SettingSingle quaternary neonatal intensive care unit in Australia.Patients20 infants spontaneously breathing (n=17) or on non-invasive ventilation (n=3), with mean (SD) gestational age at birth of 33 (5) weeks.InterventionsThirty-minute episodes of care in each position: supine cot care, prone SSC and prone cot care preceding a 10 min period of continuous electrical impedance tomography measurements of regional ventilation.Main outcome measuresIn each position, ventral–dorsal and right–left centre of ventilation (CoV), percentage of whole lung ventilation by region and percentage of apparent unventilated lung regions were determined. Heart and respiratory rates, oxygen saturation and axillary temperature were also measured.ResultsHeart and respiratory rates, oxygen saturation, temperature and right-left lung ventilation did not differ between the three positions (mixed-effects model). Ventilation generally favoured the dorsal lung, but the mean (95% CI) ventrodorsal CoV was −2.0 (−0.4 to –3.6)% more dorsal during SSC compared with prone. Supine position resulted in 5.0 (1.5 to 5.3)% and 4.5 (3.9 to 5.1)% less apparently unventilated lung regions compared with SSC and prone, respectively.ConclusionsIn clinically stable infants, SSC generates a distinct regional ventilation pattern that is independent of prone position and results in greater distribution of ventilation towards the dorsal lung.

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Regional ventilation characteristics during non-invasive respiratory support in preterm infants

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-320449 ◽

2020 ◽

pp. fetalneonatal-2020-320449

Author(s):

Jessica Thomson ◽

Christoph M Rüegger ◽

Elizabeth J Perkins ◽

Prue M Pereira-Fantini ◽

Olivia Farrell ◽

...

Keyword(s):

Oxygen Saturation ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Repeated Measure ◽

Regional Ventilation ◽

Quiet Breathing ◽

Impedance Tomography ◽

Non Invasive ◽

Ventilation Inhomogeneity ◽

The Right

ObjectivesTo determine the regional ventilation characteristics during non-invasive ventilation (NIV) in stable preterm infants. The secondary aim was to explore the relationship between indicators of ventilation homogeneity and other clinical measures of respiratory status.DesignProspective observational study.SettingTwo tertiary neonatal intensive care units.PatientsForty stable preterm infants born <30 weeks of gestation receiving either continuous positive airway pressure (n=32) or high-flow nasal cannulae (n=8) at least 24 hours after extubation at time of study.InterventionsContinuous electrical impedance tomography imaging of regional ventilation during 60 min of quiet breathing on clinician-determined non-invasive settings.Main outcome measuresGravity-dependent and right–left centre of ventilation (CoV), percentage of whole lung tidal volume (VT) by lung region and percentage of lung unventilated were determined for 120 artefact-free breaths/infant (4770 breaths included). Oxygen saturation, heart and respiratory rates were also measured.ResultsVentilation was greater in the right lung (mean 69.1 (SD 14.9)%) total VT and the gravity-non-dependent (ND) lung; ideal–actual CoV 1.4 (4.5)%. The central third of the lung received the most VT, followed by the non-dependent and dependent regions (p<0.0001 repeated-measure analysis of variance). Ventilation inhomogeneity was associated with worse peripheral capillary oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (p=0.031, r2 0.12; linear regression). In those infants that later developed bronchopulmonary dysplasia (n=25), SpO2/FiO2 was worse and non-dependent ventilation inhomogeneity was greater than in those that did not (both p<0.05, t-test Welch correction).ConclusionsThere is high breath-by-breath variability in regional ventilation patterns during NIV in preterm infants. Ventilation favoured the ND lung, with ventilation inhomogeneity associated with worse oxygenation.

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Tracheobronchial Foreign Body Aspiration Diagnosed with Electrical Impedance Tomography

Case Reports in Pediatrics ◽

10.1155/2021/9951838 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Robert D. Guglielmo ◽

Robinder G. Khemani

Keyword(s):

Foreign Body ◽

Early Diagnosis ◽

Electrical Impedance Tomography ◽

Electrical Impedance ◽

Left Lung ◽

Lung Ventilation ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

High Morbidity ◽

Impedance Tomography

Background. Foreign body aspiration (FBA) in children has a high morbidity, and early diagnosis is the key for preventing acute and chronic respiratory complications. To diagnose FBA, commonly used imaging modalities have limited negative predictive value, and rigid bronchoscopy remains as the gold standard. We present a case where the diagnosis of FBA was made in a novel way with electrical impedance tomography (EIT). Case Presentation. A 19-month-old previously healthy boy was admitted with a clinical diagnosis of respiratory failure secondary to bronchiolitis. Chest X-ray showed bilateral lung hyperinflation. He enrolled in a research study which used EIT to measure the effects of high flow nasal cannula (HFNC) on minute ventilation in children with bronchiolitis. On initiation, the patient had near-normal right lung ventilation (98%) and near-absent left lung ventilation (2%). We discontinued the study and alerted the medical team that we suspected FBA. Further imaging (lateral decubitus films and lung ultrasounds) was also obtained, but was not diagnostic. Rigid bronchoscopy was performed and showed a peanut occluding the left mainstem bronchus (LMB). The peanut was removed followed by complete resolution of the patient’s symptoms. Conclusions. We believe this is the first reported case of FBA diagnosed via EIT. EIT has been shown to be a useful but underutilized technology for diagnosing respiratory disease. While FBA remains a relatively common cause of morbidity and mortality in children less than age four, early diagnosis remains difficult and requires vigilance. This case illustrates the challenges of relying on chest films and ultrasound to assist with diagnosis and suggests that EIT in combination with a thorough history and physical exam can be used to confirm the presence of FBA.

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Effect of Early Mobilization from Bed to Wheel Chair on Regional Ventilation Distribution Assessed by Electrical Impedance Tomography in Respiratory Failure Patients

10.21203/rs.3.rs-60116/v1 ◽

2020 ◽

Author(s):

Siyi Yuan ◽

Huaiwu He ◽

Yun Long ◽

Yi Chi ◽

Zhanqi Zhao

Keyword(s):

Respiratory Failure ◽

Electrical Impedance ◽

Early Mobilization ◽

Lung Ventilation ◽

Sitting Position ◽

Ventilation Distribution ◽

Regional Ventilation ◽

Impedance Tomography ◽

Regional Lung ◽

Regional Lung Ventilation

Abstract Backgrounds: There was limited knowledge about the effect of early mobilization on regional lung ventilation in patients with respiratory failure. The aim of the study was to examine whether electrical impedance tomography (EIT) could help to predict the improvement in ventilation distribution due to mobilization.Methods: Forty-one patients with respiratory failure, who had weaned from ventilator and received early mobilization were prospectively enrolled in this study. EIT was used to assess regional lung ventilation distributions at 4 timepoints during the early mobilization from bed to wheelchair (Tbase: baseline, supine position at the bed, T30min: sitting position on the wheelchair after 30min, T60min: sitting position on the wheelchair after 60min, Treturn: return to supine position on the bed after early mobilization). The EIT-based global inhomogeneity (GI) and center of ventilation (CoV) indices were calculated. EIT images were equally divided into four ventral-to-dorsal horizontal regions of interest (ROIs 1-4). Depending on the improvement of ventilation distribution in dependent regions at T60min (threshold set to 15%), patients were divided into recruited (DR) and non-recruited (Non-DR) groups. Results: From the bed to the wheelchair, a significant and continuous increase of dependent regional ventilation distribution (ROI 3+4: baseline vs. T30min, vs. T60min: 45.9±12.1 vs. 48.7±11.6 vs. 49.9±12.6, p=0.015) and COV (COV baseline vs. T30min, vs. T60min: 48.2±10.1 vs. 50.1±9.2 vs. 50.5±9.6, p=0.003). Besides, there was a significant decrease of GI at T60min. Patients in the DR group (n=18) had significantly higher oxygenation than the Non-DR group (n=23) after early mobilization. ROI4Tbase was significantly negatively correlated to ΔSpO2 (R=0.72, p＜0.001). Using a cut-off value of 6.5%, ROI4Tbase had a 79.2% specificity and 58.8% sensitivity to predict response of dependent region recruitment due to early mobilization. The corresponding area under curve was 0.806 (95%CI, 0.677-0.936).Conclusions: EIT may be a promising tool to predict the ventilation improvement resulted from early mobilization.Trial registration: Effect of Early Mobilization on Regional Lung Ventilation Assessed by EIT, NCT04081129. Registered 9 June 2019 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00096WT&selectaction=Edit&uid=U00020D9&ts=2&cx=v2cwij

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Assessment of Postnatal Pulmonary Adaption in Bovine Neonates Using Electric Impedance Tomography (EIT)

Animals ◽

10.3390/ani11113216 ◽

2021 ◽

Vol 11 (11) ◽

pp. 3216

Author(s):

Ulrich Bleul ◽

Corina Wey ◽

Carolina Meira ◽

Andreas Waldmann ◽

Martina Mosing

Keyword(s):

Left Lung ◽

Lung Ventilation ◽

Electric Impedance ◽

Electric Impedance Tomography ◽

Impedance Tomography ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Gravity Driven ◽

Neonatal Calves ◽

The Right

Several aspects of postnatal pulmonary adaption in the bovine neonate remain unclear, particularly the dynamics and regional ventilation of the lungs. We used electric impedance tomography (EIT) to measure changes in ventilation in the first 3 weeks of life in 20 non-sedated neonatal calves born without difficulty in sternal recumbency. Arterial blood gas variables were determined in the first 24 h after birth. Immediately after birth, dorsal parts of the lungs had 4.53% ± 2.82% nondependent silent spaces (NSS), and ventral parts had 5.23% ± 2.66% dependent silent spaces (DSS). The latter increased in the first hour, presumably because of gravity-driven ventral movement of residual amniotic fluid. The remaining lung regions had good ventilation immediately after birth, and the percentage of lung regions with high ventilation increased significantly during the study period. The centre of ventilation was always dorsal to and on the right of the theoretical centre of ventilation. The right lung was responsible for a significantly larger proportion of ventilation (63.84% ± 12.74%, p < 0.00001) compared with the left lung. In the right lung, the centrodorsal lung area was the most ventilated, whereas, in the left lung, it was the centroventral area. Tidal impedance changes, serving as a surrogate for tidal volume, increased in the first 3 weeks of life (p < 0.00001). This study shows the dynamic changes in lung ventilation in the bovine neonate according to EIT measurements. The findings form a basis for the recognition of structural and functional lung disorders in neonatal calves.

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06 / Intraoperative regional cerebral oxygen saturation monitoring using near infrared spectroscopy device during spinal neurosurgery in prone position and postoperative cognitive dysfunction

10.26226/morressier.5aeb0ac907b0d6001a79a656 ◽

2018 ◽

Author(s):

Sniedze Murniece

Keyword(s):

Infrared Spectroscopy ◽

Oxygen Saturation ◽

Cognitive Dysfunction ◽

Prone Position ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Postoperative Cognitive Dysfunction ◽

Cerebral Oxygen Saturation ◽

Cerebral Oxygen ◽

Regional Cerebral Oxygen Saturation

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P.77 Skin-to-skin care during caesarean section in two obstetric units

International Journal of Obstetric Anesthesia ◽

10.1016/j.ijoa.2021.103075 ◽

2021 ◽

Vol 46 ◽

pp. 103075

Author(s):

K.V. Bosworth ◽

Y. Mustafa ◽

M. Aukland ◽

A. Bhat ◽

G. Kelly

Keyword(s):

Caesarean Section ◽

Skin Care ◽

Skin To Skin

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Electrical impedance tomography to measure lung ventilation distribution in healthy horses and horses with left‐sided cardiac volume overload

Journal of Veterinary Internal Medicine ◽

10.1111/jvim.16227 ◽

2021 ◽

Author(s):

Muriel Sacks ◽

David P. Byrne ◽

Nicolas Herteman ◽

Cristy J.Cristy Secombe ◽

Andy Adler ◽

...

Keyword(s):

Electrical Impedance Tomography ◽

Electrical Impedance ◽

Volume Overload ◽

Lung Ventilation ◽

Ventilation Distribution ◽

Cardiac Volume ◽

Impedance Tomography

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Impact of artificial airway resistances on regional ventilation distribution during airway closure

Current Directions in Biomedical Engineering ◽

10.1515/cdbme-2020-3009 ◽

2020 ◽

Vol 6 (3) ◽

pp. 32-35

Author(s):

Melanie März ◽

Sarah Howe ◽

Bernhard Laufer ◽

Knut Moeller ◽

Sabine Krueger-Ziolek

Keyword(s):

Pulmonary Function ◽

Airway Resistance ◽

Airway Closure ◽

Ventilation Distribution ◽

Regional Ventilation ◽

Impedance Tomography ◽

Artificial Airway ◽

Normal Breathing ◽

Airway Obstructions ◽

Forced Breathing

AbstractElectrical impedance tomography (EIT), a noninvasive and radiation-free imaging technique can be used in pulmonary function monitoring for determining regional ventilation distribution within the lung. Gold standard in pulmonary function monitoring is spirometry/body plethysmography, a method using forced breathing maneuvers to obtain global lung function parameters. However, this method is heavily dependent on the cooperation of the patients. Within this observational study, a method under normal breathing was tested with 5 healthy volunteers, which provides regional information about ventilation distribution. The occlusion method Rocc, a method for determining airway resistance, was used to create a short-term airway closure. Regional ventilation during the airway closure was examined with EIT. Simultaneously four different artificial airway resistances were used to simulate airway obstructions. Results show that EIT in combination with the ROcc method is suitable for the detection of regional differences in ventilation during airway closure for all four artificial airway resistances. Although the sum of relative impedances at the end of the shutter maneuver are smaller (nearly -0.100 AU) for the airway resistances Ø 12.5 mm, Ø 10.5 mm and Ø 9.5 mm than for the smallest one with Ø 30.0 mm (~ -0.070 AU), the changes in impedance from the start to the end of the shutter maneuver differs only slightly between the four artificial airway resistances. All impedance changes are in the range of 0.100 to 0.130 AU. The combination of EIT and the ROcc method provides not only global parameters such as airway resistance under normal breathing conditions, but also results of regional ventilation, which could enable the identification of areas affected by airway obstructions. However, the obtained results indicate that EIT might be a useful tool in the diagnosis and follow-up of obstructive lung diseases.

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