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Bedside Selection of Positive End Expiratory Pressure by Electric Impendence Tomography in Severe Acute Pancreatitis with Hypoxemia Patients
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A5139 - Bedside Selection of Positive End Expiratory Pressure by Electric Impendence Tomography in Severe Acute Pancreatitis with Hypoxemia Patients
Author Block: S. Peng1, H. Teng1, C. Zhang1, M. Chang1, H. Chang2, C. Gow1; 1Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, 2Department of Critical Care Medicine, Far Eastern Memorial Hosp, New Taipei City, Taiwan.
Introduction: Severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS) associated very high mortality rate. The optimal positive end expiratory pressure (PEEP) selection for such patients remains to be determined. Methods: We conducted a prospective serial case study in a tertiary medical center to apply the optimal PEEP for patients diagnosed as SAP associated ARDS. The optimal PEEP was determined by electric impendence tomography (EIT) on the first day of ARDS developed. We maintained optimal PEEP for 72 hours with low tidal volume strategy. The pre and post PaO2/FiO2 (P/F) was recorded and clinical outcome was measured. Results: Eight consecutive patients suffered from the computed tomography severity index Balthazar grade E complicated with moderate to severe ARDS were included, and 6 patients received EIT-guided PEEP selection. The median age was 37 (28-67) years. The APACHI scores on admission and 24 hours were 22±6 and 24±5, respectively. The EIT-guided optimal PEEP was 17±1.5 cmH20. The PaO2/FiO2 (P/F) ratios of pre- and 24-hr-post optimal PEEP were 82±32 and 185±116, respectively. The in-hospital mortality rate was 33% (2 of 6). The survival patients had similar median age (40 vs 35 years), better APACHI scores on admission (20 vs 25), higher PEEP applied (17.5 vs 16 cmH20), better pre-PEEP P/F ratio (96 vs 56), and much better post PEEP P/F ratio increments (144% vs 39%). Another two cases received flow-volume curve based PEEP selection (PEEP=14 and 15 cmH20) were non-survival (mortality rate 100%). These two cases had very poor pre-post P/F ratio increments (11%) after selected PEEP use. Conclusions: EIT-guided optimal PEEP selection improved post PEEP P/F ratio in SAP associated ARDS patients who survived. The adjuvant role of EIT in such patients warrants further randomized trial investigation.
Author Block: S. Peng1, H. Teng1, C. Zhang1, M. Chang1, H. Chang2, C. Gow1; 1Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, 2Department of Critical Care Medicine, Far Eastern Memorial Hosp, New Taipei City, Taiwan.
Introduction: Severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS) associated very high mortality rate. The optimal positive end expiratory pressure (PEEP) selection for such patients remains to be determined. Methods: We conducted a prospective serial case study in a tertiary medical center to apply the optimal PEEP for patients diagnosed as SAP associated ARDS. The optimal PEEP was determined by electric impendence tomography (EIT) on the first day of ARDS developed. We maintained optimal PEEP for 72 hours with low tidal volume strategy. The pre and post PaO2/FiO2 (P/F) was recorded and clinical outcome was measured. Results: Eight consecutive patients suffered from the computed tomography severity index Balthazar grade E complicated with moderate to severe ARDS were included, and 6 patients received EIT-guided PEEP selection. The median age was 37 (28-67) years. The APACHI scores on admission and 24 hours were 22±6 and 24±5, respectively. The EIT-guided optimal PEEP was 17±1.5 cmH20. The PaO2/FiO2 (P/F) ratios of pre- and 24-hr-post optimal PEEP were 82±32 and 185±116, respectively. The in-hospital mortality rate was 33% (2 of 6). The survival patients had similar median age (40 vs 35 years), better APACHI scores on admission (20 vs 25), higher PEEP applied (17.5 vs 16 cmH20), better pre-PEEP P/F ratio (96 vs 56), and much better post PEEP P/F ratio increments (144% vs 39%). Another two cases received flow-volume curve based PEEP selection (PEEP=14 and 15 cmH20) were non-survival (mortality rate 100%). These two cases had very poor pre-post P/F ratio increments (11%) after selected PEEP use. Conclusions: EIT-guided optimal PEEP selection improved post PEEP P/F ratio in SAP associated ARDS patients who survived. The adjuvant role of EIT in such patients warrants further randomized trial investigation.
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