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Dynamic inflation prevents and standardized lung recruitment reverts volume loss associated with percutaneous tracheostomy during volume control ventilation: results from a Neuro-ICU population

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Abstract

To determine how percutaneous tracheostomy (PT) impacts on respiratory system compliance (Crs) and end-expiratory lung volume (EELV) during volume control ventilation and to test whether a recruitment maneuver (RM) at the end of PT may reverse lung derecruitment. This is a single center, prospective, applied physiology study. 25 patients with acute brain injury who underwent PT were studied. Patients were ventilated in volume control ventilation. Electrical impedance tomography (EIT) monitoring and respiratory mechanics measurements were performed in three steps: (a) baseline, (b) after PT, and (c) after a standardized RM (10 sighs of 30 cmH2O lasting 3 s each within 1 min). End-expiratory lung impedance (EELI) was used as a surrogate of EELV. PT determined a significant EELI loss (mean reduction of 432 arbitrary units p = 0.049) leading to a reduction in Crs (55 ± 13 vs. 62 ± 13 mL/cmH2O; p < 0.001) as compared to baseline. RM was able to revert EELI loss and restore Crs (68 ± 15 vs. 55 ± 13 mL/cmH2O; p < 0.001). In a subgroup of patients (N = 8, 31%), we observed a gradual but progressive increase in EELI. In this subgroup, patients did not experience a decrease of Crs after PT as compared to patients without dynamic inflation. Dynamic inflation did not cause hemodynamic impairment nor raising of intracranial pressure. We propose a novel and explorative hyperinflation risk index (HRI) formula. Volume control ventilation did not prevent the PT-induced lung derecruitment. RM could restore the baseline lung volume and mechanics. Dynamic inflation is common during PT, it can be monitored real-time by EIT and anticipated by HRI. The presence of dynamic inflation during PT may prevent lung derecruitment.

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No datasets were generated or analysed during the current study.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Viale Ghirotti 286, Cesena, 47521, Italy

    Luca Bastia

  2. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    Roberta Garberi & Emanuele Rezoagli

  3. Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Lorenzo Querci, Cristiana Cipolla & Arturo Chieregato

  4. ASST Brianza, Ospedale di Vimercate, Vimercate, Italy

    Francesco Curto

  5. Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, Italy

    Emanuele Rezoagli

  6. Department of Anesthesia and Intensive Care, University of Milano-Bicocca, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy

    Roberto Fumagalli

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  1. Luca Bastia
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  2. Roberta Garberi
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Contributions

LB conceived the study and interpreted the data; LB and RG conducted the study, analyzed the data, wrote the manuscript; LQ and ER analyzed the data and revised the manuscript; CC supported technically the work; FC organized the work and revised the manuscript; RF and AC interpreted the data and revised the manuscript; AC was overall supervisor.

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Correspondence to Luca Bastia.

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Bastia, L., Garberi, R., Querci, L. et al. Dynamic inflation prevents and standardized lung recruitment reverts volume loss associated with percutaneous tracheostomy during volume control ventilation: results from a Neuro-ICU population. J Clin Monit Comput (2024). https://doi.org/10.1007/s10877-024-01174-x

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