Continuous non-invasive monitoring of tidal volumes by measurement of tidal impedance in neonatal piglets

Background

Electrical Impedance measurements can be used to estimate the content of intra-thoracic air and thereby give information on pulmonary ventilation. Conventional Impedance measurements mainly indicate relative changes, but no information concerning air-volume is given. The study was performed to test whether a 3-point-calibration with known tidal volumes (VT) during conventional mechanical ventilation (CMV) allows subsequent calculation of VT from total Tidal-Impedance (tTI) measurements using Quadrant Impedance Measurement (QIM). In addition the distribution of TI in different regions of the thorax was examined.

Methodology and Principal Findings

QIM was performed in five neonatal piglets during volume-controlled CMV. tTI values at three different VT (4, 6, 8 ml/kg) were used to establish individual calibration curves. Subsequently, each animal was ventilated with different patterns of varying VT (2–10 ml/kg) at different PEEP levels (0, 3, 6, 9, 12 cmH₂O). VT variation was repeated after surfactant depletion by bronchoalveolar lavage. VT was calculated from tTI values (VT_calc) and compared to the VT delivered by the ventilator (VT_PNT). Bland-Altman analysis revealed good agreement between VT_calc and VT_PNT before (bias −0.08 ml; limits of agreement −1.18 to 1.02 ml at PEEP = 3 cmH₂O) and after surfactant depletion (bias −0.17 ml; limits of agreement −1.57 to 1.22 ml at PEEP = 3 cmH₂O). At higher PEEP levels VT_calc was lower than VT_PNT, when only one fixed calibration curve (at PEEP 3 cmH₂O) was used. With a new calibration curve at each PEEP level the method showed similar accuracy at each PEEP level. TI showed a homogeneous distribution over the four assessed quadrants with a shift toward caudal regions of the thorax with increasing VT.

Conclusion

Tidal Impedance values could be used for precise and accurate calculation of VT during CMV in this animal study, when calibrated at each PEEP level.