Personalized PEEP & Weaning

Protective mechanical ventilation for enhanced recovery

Personalized PEEP & Weaning2020-09-30T18:38:12+00:00
Clinical Need

Millions of patients are mechanically ventilated every year in ICU and OR. High air pressure from the mechanical ventilator often causes a ventilator-associated lung injury (VALI) by overly inflating some parts of the lungs, leading to life-threatening ARDS (acute respiratory distress syndrome).  To solve this unmet clinical need, lung protective ventilation (LPV) should be pursued for all mechanically-ventilated patients.  This requires (1) finding an optimal PEEP (positive end-expiratory pressure) value for each patient and (2) continuous bedside monitoring of regional air distributions in the lungs.

Mechanical ventilation is an essential life-saving therapy for patients with critical illness and respiratory failure. More than 300,000 patients receive mechanical ventilation in the U.S. each year. These patients are at high risk for complications and poor outcomes including death related with Ventilatory-Associated Events (VAE). Such complications can lead to longer duration of mechanical ventilation, longer stays in the ICU and hospital, increased healthcare costs, and increased risk of disability and death. Motality in patients with acute lung injury on mechanical ventilation has been estimated to range from 24% in persons 15-19 years of age to 60% for patients 85 years and older.  (From https://www.cdc.gov/nhsn/pdfs/pscmanual/10-vae_final.pdf)

Current Practices

Mechanical ventilators provide pressure, volume, and flow data continuously. However, they represent the entire lungs, and do not provide information about specific lung regions regarding collapse and overdistension. Although imaging methods such as X-ray CT and chest X-rays could visualize collapsed parts of the lungs, they cannot be used for continuous bedside monitoring. Currently, there is no method to determine an optimal PEEP for each patient.

Solution

Electrical impedance tomography (EIT) is the only method currently available for continuous monitoring of regional air distributions in the lungs. BiLab provides an innovative solution for protective mechanical ventilation. Its latest portable EIT device continuously visualizes and monitors regional air distributions in the lungs and tracks any changes in collapsed and/or overdistended parts. Using EIT, an optimal PEEP value can be determined for each individual patient by conducting a PEEP maneuver procedure whenever needed, thus enabling personalized protective lung ventilation. The same EIT device assists a protocolized weaning procedure by monitoring breath-by-breath tidal volume, respiration rate, and minute ventilation during spontaneous breathing.