Intensive Care Medicine

, Volume 42, Issue 10, pp 1576–1587 | Cite as

Bedside assessment of the effects of positive end-expiratory pressure on lung inflation and recruitment by the helium dilution technique and electrical impedance tomography

  • Tommaso Mauri
  • Nilde Eronia
  • Cecilia Turrini
  • Marta Battistini
  • Giacomo Grasselli
  • Roberto Rona
  • Carlo Alberto Volta
  • Giacomo Bellani
  • Antonio PesentiEmail author



Higher positive end-expiratory pressure might induce lung inflation and recruitment, yielding enhanced regional lung protection. We measured positive end-expiratory pressure-related lung volume changes by electrical impedance tomography and by the helium dilution technique. We also used electrical impedance tomography to assess the effects of positive end-expiratory pressure on regional determinants of ventilator-induced lung injury.


A prospective randomized crossover study was performed on 20 intubated adult patients: 12 with acute hypoxemic respiratory failure and 8 with acute respiratory distress syndrome. Each patient underwent protective controlled ventilation at lower (7 [7, 8] cmH2O) and higher (12 [12, 13] cmH2O) positive end-expiratory pressures. At the end of each phase, we collected ventilation, helium dilution, and electrical impedance tomography data.


Positive end-expiratory pressure-induced changes in lung inflation and recruitment measured by electrical impedance tomography and helium dilution showed close correlations (R 2 = 0.78, p < 0.001 and R 2 = 0.68, p < 0.001, respectively) but with relatively variable limits of agreement. At higher positive end-expiratory pressure, recruitment was evident in all lung regions (p < 0.01) and heterogeneity of tidal ventilation distribution was reduced by increased tidal volume distending the dependent lung (p < 0.001); in the non-dependent lung, on the other hand, compliance decreased (p < 0.001) and tidal hyperinflation significantly increased (p < 0.001). In the subgroup of ARDS patients (but not in the whole study population) tidal hyperinflation in the dependent lung regions decreased at higher positive end-expiratory pressure (p = 0.05), probably indicating higher potential for recruitment.


Close correlations exist between bedside assessment of positive end-expiratory pressure-induced changes in lung inflation and recruitment by the helium dilution and electrical impedance tomography techniques. Higher positive end-expiratory pressure exerts mixed effects on the regional determinants of ventilator-induced lung injury; these merit close monitoring.


Acute respiratory distress syndrome Mechanical ventilation Positive end-expiratory pressure Ventilator-induced lung injury Lung volume measurements Electrical impedance 



The present study was supported by departmental funding.

Compliance with ethical standards

Conflicts of interest

The authors have no conflict of interest to declare.

Supplementary material

134_2016_4467_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 25 kb)
134_2016_4467_MOESM2_ESM.avi (499 kb)
Supplementary material 2 (AVI 499 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  1. 1.Department of Anesthesia, Critical Care and EmergencyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Department of EmergencySan Gerardo HospitalMonzaItaly
  3. 3.Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive CareUniversity of FerraraFerraraItaly
  4. 4.Department of Medicine and SurgeryUniversity of Milan-BicoccaMonzaItaly
  5. 5.Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly

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