Homogeneous ventilation is important for prevention of ventilator-induced lung injury. Electrical impedance tomography (EIT) has been used to identify optimal PEEP by detection of homogenous ventilation in non-dependent and dependent lung regions. We aimed to compare the ability of volumetric capnography and EIT in detecting homogenous ventilation between these lung regions.
Fifteen mechanically-ventilated patients after cardiac surgery were studied. Ventilator settings were adjusted to volume-controlled mode with a fixed tidal volume (Vt) of 6–8 ml kg −1 predicted body weight. Different PEEP levels were applied (14 to 0 cm H 2O, in steps of 2 cm H 2O) and blood gases, Vcap and EIT were measured.
Tidal impedance variation of the non-dependent region was highest at 6 cm H 2O PEEP, and decreased significantly at 14 cm H 2O PEEP indicating decrease in the fraction of Vt in this region. At 12 cm H 2O PEEP, homogenous ventilation was seen between both lung regions. Bohr and Enghoff dead space calculations decreased from a PEEP of 10 cm H 2O. Alveolar dead space divided by alveolar Vt decreased at PEEP levels ≤6 cm H 2O. The normalized slope of phase III significantly changed at PEEP levels ≤4 cm H 2O. Airway dead space was higher at higher PEEP levels and decreased at the lower PEEP levels.