PDF(Pubmed)
Abstract：
BACKGROUND: Bronchoscopic lung volume reduction (BLVR) with one-way endobronchial valves (EBV) has better outcomes when the target lobe has poor collateral ventilation, resulting in complete lobe atelectasis. High-inspired oxygen fraction (FIO2) promotes atelectasis through faster gas absorption after airway occlusion, but its application during BLVR with EBV has been poorly understood. We aimed to investigate the real-time effects of FIO2 on regional lung volumes and regional ventilation/perfusion by electrical impedance tomography (EIT) during BLVR with EBV.
METHODS: Six piglets were submitted to left lower lobe occlusion by a balloon-catheter and EBV valves with FIO2 0.5 and 1.0. Regional end-expiratory lung impedances (EELI) and regional ventilation/perfusion were monitored. Local pocket pressure measurements were obtained (balloon occlusion method). One animal underwent simultaneous acquisitions of computed tomography (CT) and EIT. Regions-of-interest (ROIs) were right and left hemithoraces.
RESULTS: Following balloon occlusion, a steep decrease in left ROI-EELI with FIO2 1.0 occurred, 3-fold greater than with 0.5 (p < 0.001). Higher FIO2 also enhanced the final volume reduction (ROI-EELI) achieved by each valve (p < 0.01). CT analysis confirmed the denser atelectasis and greater volume reduction achieved by higher FIO2 (1.0) during balloon occlusion or during valve placement. CT and pocket pressure data agreed well with EIT findings, indicating greater strain redistribution with higher FIO2.
CONCLUSIONS: EIT demonstrated in real-time a faster and more complete volume reduction in the occluded lung regions under high FIO2 (1.0), as compared to 0.5. Immediate changes in the ventilation and perfusion of ipsilateral non-target lung regions were also detected, providing better estimates of the full impact of each valve in place.
BACKGROUND: Not applicable.
METHODS: Six piglets were submitted to left lower lobe occlusion by a balloon-catheter and EBV valves with FIO2 0.5 and 1.0. Regional end-expiratory lung impedances (EELI) and regional ventilation/perfusion were monitored. Local pocket pressure measurements were obtained (balloon occlusion method). One animal underwent simultaneous acquisitions of computed tomography (CT) and EIT. Regions-of-interest (ROIs) were right and left hemithoraces.
RESULTS: Following balloon occlusion, a steep decrease in left ROI-EELI with FIO2 1.0 occurred, 3-fold greater than with 0.5 (p < 0.001). Higher FIO2 also enhanced the final volume reduction (ROI-EELI) achieved by each valve (p < 0.01). CT analysis confirmed the denser atelectasis and greater volume reduction achieved by higher FIO2 (1.0) during balloon occlusion or during valve placement. CT and pocket pressure data agreed well with EIT findings, indicating greater strain redistribution with higher FIO2.
CONCLUSIONS: EIT demonstrated in real-time a faster and more complete volume reduction in the occluded lung regions under high FIO2 (1.0), as compared to 0.5. Immediate changes in the ventilation and perfusion of ipsilateral non-target lung regions were also detected, providing better estimates of the full impact of each valve in place.
BACKGROUND: Not applicable.
摘要：
背景：当目标肺叶侧支通气不良时，采用单向支气管瓣膜（EBV）的支气管镜肺减容术（BLVR）具有更好的结果，导致肺叶完全不张.高吸入氧气分数（FIO2）通过气道阻塞后更快的气体吸收促进肺不张，但它在BLVR与EBV的应用却知之甚少。我们旨在通过电阻抗断层扫描（EIT）研究在BLVR和EBV期间FIO2对区域肺容量和区域通气/灌注的实时影响。
方法：6只仔猪接受球囊导管和EBV瓣膜的左下叶闭塞，FIO2为0.5和1.0。监测区域性呼气末肺阻抗（EELI）和区域性通气/灌注。获得局部袋压力测量值(球囊闭塞法)。一只动物同时进行计算机断层扫描（CT）和EIT采集。感兴趣的区域(ROI)是右和左半胸部。
结果：球囊闭塞后，左ROI-EELI急剧下降，FIO2为1.0，比0.5大3倍（p<0.001）。较高的FIO2还增强了每个瓣膜实现的最终体积减少(ROI-EELI)(p<0.01)。CT分析证实，在球囊闭塞或瓣膜放置期间，较高的FIO2（1.0）可实现更密集的肺不张和更大的体积减少。CT和口袋压力数据与EIT结果吻合良好，表明更大的应变再分布与更高的FIO2。
结论：EIT实时显示，在高FIO2（1.0）的情况下，闭塞的肺部区域的体积减小更快，更彻底，与0.5相比。还检测到同侧非靶肺区域的通气和灌注的即时变化，提供对每个阀门到位的全部影响的更好估计。
背景：不适用。
方法：6只仔猪接受球囊导管和EBV瓣膜的左下叶闭塞，FIO2为0.5和1.0。监测区域性呼气末肺阻抗（EELI）和区域性通气/灌注。获得局部袋压力测量值(球囊闭塞法)。一只动物同时进行计算机断层扫描（CT）和EIT采集。感兴趣的区域(ROI)是右和左半胸部。
结果：球囊闭塞后，左ROI-EELI急剧下降，FIO2为1.0，比0.5大3倍（p<0.001）。较高的FIO2还增强了每个瓣膜实现的最终体积减少(ROI-EELI)(p<0.01)。CT分析证实，在球囊闭塞或瓣膜放置期间，较高的FIO2（1.0）可实现更密集的肺不张和更大的体积减少。CT和口袋压力数据与EIT结果吻合良好，表明更大的应变再分布与更高的FIO2。
结论：EIT实时显示，在高FIO2（1.0）的情况下，闭塞的肺部区域的体积减小更快，更彻底，与0.5相比。还检测到同侧非靶肺区域的通气和灌注的即时变化，提供对每个阀门到位的全部影响的更好估计。
背景：不适用。
