Effect of Electrical Impedance Tomography-Guided Early Mobilization in Patients After Major Upper Abdominal Surgery: Protocol for a Prospective Cohort Study

Background: Pulmonary complications are common in patients after upper abdominal surgery, resulting in poor clinical outcomes and increased costs of hospitalization. Enhanced Recovery After Surgery Guidelines strongly recommend early mobilization post-operatively; however, the quality of the evidence is poor, and indicators for quantifying the effectiveness of early mobilization are lacking. This study will evaluate the effectiveness of early mobilization in patients undergoing an upper abdominal surgery using electrical impedance tomography (EIT). Specifically, we will use EIT to assess and compare the lung ventilation distribution among various regions of interest (ROI) before and after mobilization in this patient population. Additionally, we will assess the temporal differences in the distribution of ventilation in various ROI during mobilization in an effort to develop personalized activity programs for this patient population.Methods: In this prospective, single-center cohort study, we aim to recruit 50 patients after upper abdominal surgery between July 1, 2021 and June 30, 2022. This study will use EIT to quantify the ventilation distribution among different ROI. On post-operative day 1, the nurses will assist the patient to sit on the chair beside the bed. Patient's heart rate, blood pressure, oxygen saturation, respiratory rate, and ROI 1-4 will be recorded before the mobilization as baseline. These data will be recorded again at 15, 30, 60, 90, and 120 min after mobilization, and the changes in vital signs and ROI 1-4 values at each time point before and after mobilization will be compared.Ethics and Dissemination: The study protocol has been approved by the Institutional Review Board of Liaocheng Cardiac Hospital (2020036). The trial is registered at chictr.org.cn with identifier ChiCTR2100042877, registered on January 31, 2021. The results of the study will be presented at relevant national and international conferences and submitted to international peer-reviewed journals. There are no plans to communicate results specifically to participants. Important protocol modifications, such as changes to eligibility criteria, outcomes, or analyses, will be communicated to all relevant parties (including investigators, Institutional Review Board, trial participants, trial registries, journals, and regulators) as needed via email or in-person communication.

Download Full-text

Electrical Impedance Tomography Predicts Weaning Success in Adult Patients With Delayed Upper Abdominal Surgery: A Single-Center Retrospective Study

Frontiers in Medicine ◽

10.3389/fmed.2021.748493 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jiajia Li ◽

Fan Zeng ◽

Fuxun Yang ◽

Xiaoxiu Luo ◽

Rongan Liu ◽

...

Keyword(s):

Abdominal Surgery ◽

Electrical Impedance Tomography ◽

Predictive Value ◽

Electrical Impedance ◽

Characteristic Curve ◽

Ventilator Weaning ◽

Impedance Tomography ◽

Upper Abdominal Surgery ◽

Generalized Estimation Equation ◽

Upper Abdominal

Objective: To evaluate the predictive value of electrical impedance tomography (EIT) in patients with delayed ventilator withdrawal after upper abdominal surgery.Methods: We retrospectively analyzed data of patients who were ventilated >24 h after upper abdominal surgery between January 2018 and August 2019. The patients were divided into successful (group S) and failed (group F) weaning groups. EIT recordings were obtained at 0, 5, 15, and 30 min of spontaneous breathing trials (SBTs) with SBT at 0 min set as baseline. We assessed the change in delta end-expiratory lung impedance and tidal volume ratio (ΔEELI/VT) from baseline, the change in compliance change percentage variation (|Δ(CW-CL)|) from baseline, the standard deviation of regional ventilation delay index (RVDSD), and global inhomogeneity (GI) using generalized estimation equation analyses. Receiver operating characteristic curve analyses were performed to evaluate the predictive value of parameters indicating weaning success.Results: Among the 32 included patients, ventilation weaning was successful in 23 patients but failed in nine. Generalized estimation equation analysis showed that compared with group F, the ΔEELI/VT was lower, and the GI, RVDSD, and (|Δ(CW-CL)|) were higher in group S. For predicting withdrawal failure, the areas under the curve of the ΔEELI/VT, (|Δ(CW-CL)|), and the RVDSD were 0.819, 0.918, and 0.918, and 0.816, 0.884, and 0.918 at 15 and 30 min during the SBTs, respectively.Conclusion: The electrical impedance tomography may predict the success rate of ventilator weaning in patients with delayed ventilator withdrawal after upper abdominal surgery.

Download Full-text

Monitoring intraoperative tidal volume distribution using electrical impedance tomography during upper abdominal surgery

European Journal of Anaesthesiology ◽

10.1097/00003643-201006121-00315 ◽

2010 ◽

Vol 27 ◽

pp. 99

Author(s):

M. S. Schaefer ◽

B. Bastin ◽

U. Schmalz ◽

V. Wania ◽

T. A. Treschan

Keyword(s):

Abdominal Surgery ◽

Tidal Volume ◽

Electrical Impedance Tomography ◽

Electrical Impedance ◽

Volume Distribution ◽

Impedance Tomography ◽

Upper Abdominal Surgery ◽

Upper Abdominal

Download Full-text

Electrical impedance tomography during major open upper abdominal surgery: a pilot-study

BMC Anesthesiology ◽

10.1186/1471-2253-14-51 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 16

Author(s):

Maximilian S Schaefer ◽

Viktoria Wania ◽

Bea Bastin ◽

Ursula Schmalz ◽

Peter Kienbaum ◽

...

Keyword(s):

Pilot Study ◽

Abdominal Surgery ◽

Electrical Impedance Tomography ◽

Electrical Impedance ◽

Impedance Tomography ◽

Upper Abdominal Surgery ◽

Upper Abdominal

Download Full-text

The Effect of Upper Abdominal Surgery on the Relationship of Airway Closing Point to End Tidal Position

Clinical Science ◽

10.1042/cs0430137 ◽

1972 ◽

Vol 43 (2) ◽

pp. 137-141 ◽

Cited By ~ 16

Author(s):

J. I. Alexander ◽

P. W. Horton ◽

W. T. Millar ◽

R. K. Parikh ◽

A. A. Spence

Keyword(s):

Abdominal Surgery ◽

Significant Negative Correlation ◽

Contributory Factor ◽

Upper Abdominal Surgery ◽

Before And After ◽

End Tidal ◽

Upper Abdominal ◽

Relationship Of ◽

The Relationship ◽

Arterial Po2

1. The relationship between end tidal position (ETP) and the point of lung emptying at which there is significant airways closure (CP) has been investigated before and after upper abdominal surgery in thirty-one patients. 2. A significant negative correlation between the index (ETP-CP) and the alveolar-arterial Po2 difference (A-ado2) was found. 3. Nineteen of these patients had a vagotomy and drainage operation and, in this group, there was a greater fall in ETP than in CP in the first and second postoperative days. 4. It is suggested that airway closure is a contributory factor to the known hypoxaemia following abdominal surgery.

Download Full-text

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

Download Full-text