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Apport de la tomographie par impédance électrique pour personnaliser la ventilation mécanique au cours du syndrome de détresse respiratoire aigu réfractaire traité par ECMO veino-veineuse

Abstract : The monitoring of physiopathological consequences of the mechanical ventilation seems to be fundamental for the management of patients assisted with veno-venous ECMO for refractory acute respiratory distress syndrome (ARDS). Electrical impedance tomography (EIT) allows a direct visualization and quantification of tidal volume (VT) distribution within the lungs during a positive end-expiratory pressure (PEEP) trial despite very low VT. It reflects the wide heterogeneity of ARDS damages between patients, illustrating the variability of “optimal PEEP” levels. We have demonstrated that EIT may describe the switch of VT distribution from ventral to dorsal regions during a 16-hours prone positioning session. In addition, VT distribution before the procedure could help the clinician to anticipate the patient’s reaction to the procedure. Furthermore, evolution of “optimal PEEP” suggests the need to reassess PEEP levels during prone-positioning. Lastly, our results illustrate the potential negative impact of broncho-alveolar lavage on regional ventilation, mainly on patients without lung injury or with mild ARDS. On the other hand, moderate or severe ARDS patients don’t seem to be significantly impacted by BAL, whether for regional ventilation, end-expiratory lung volume, blood gas or global compliance. Our works suggest that EIT could become a valuable tool for physiopathological research on mechanical ventilation for ARDS patients assisted with veno-venous ECMO. Further studies are now warranted to evaluate the potential benefit of a daily monitoring of patients using EIT.
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https://tel.archives-ouvertes.fr/tel-03679025
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Submitted on : Wednesday, May 25, 2022 - 5:33:34 PM
Last modification on : Monday, May 30, 2022 - 12:02:27 PM

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  • HAL Id : tel-03679025, version 1

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Guillaume Franchineau. Apport de la tomographie par impédance électrique pour personnaliser la ventilation mécanique au cours du syndrome de détresse respiratoire aigu réfractaire traité par ECMO veino-veineuse. Médecine humaine et pathologie. Sorbonne Université, 2021. Français. ⟨NNT : 2021SORUS348⟩. ⟨tel-03679025⟩

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