Electrical Impedance Tomography for Optimal Positive End-Expiratory Pressure Application in Unilateral Acute Lung Injury with Profound Hypoxemia: A Case Report

利用電阻抗斷層攝影找出單側急性肺損傷併嚴重低血氧患者最佳吐氣末正壓：一案例報告

張建群(Chan-Chun Chang) ； 高劍虹(Chien-Hung Gow) ； 許永隆(Yeong-Long Hsu)

《胸腔醫學》 34卷3期 (2019/06) Pp. 110-118

摘要

Massive aspiration pneumonia with unilateral acute lung injury and profound hypoxemia is a common condition seen in the intensive care unit (ICU). Application of optimal positive end-expiratory pressure (PEEP) based on acute respiratory distress syndrome network guidelines may over-distend the uninvolved, more compliant lung. Some of these patients may require double lumen endotracheal intubation and independent lung ventilation to rescue the worsening ventilation/perfusion mismatch and decreasing oxygenation during suboptimal PEEP titrations. Electrical impedance tomography (EIT) is a non-invasive and portable lung imaging technique for dynamic evaluation of lung volume distribution. The reliability of EIT has been validated by comparing it with different conventional methods. Application of EIT in the ICU has been proposed for patients with mild, moderate, and severe lung disease, for assessing ventilation distribution, or even for guiding respiratory therapies. Here, we presented a patient with massive aspiration pneumonia with unilateral acute lung injury. Under real-time EIT, the PEEP was adjusted to optimal levels, and the patient was eventually successfully extubated without sequelae.

關鍵字

electrical impedance tomography ； optimal positive end expiratory pressure ； unilateral acute lung injury

並列摘要

單側急性肺損傷併嚴重低血氧在加護病房並非不常見。若是根據急性呼吸窘迫症候群聯網所建議之最佳吐氣末正壓值使用在這些病人的呼吸器設定上，可能會造成正常順應性的單側肺過度充氣。一部分這類病人在上述不適當之吐氣末正壓設定下，可能造成加重通氣／灌流與血氧和之惡化，甚至需使用到雙側肺獨立通氣之機械通氣設定。肺部電阻抗斷層攝影，一種新式無輻射、非侵入性、可重覆操作且可提供即時肺部氣體容積分布的影像檢查，其可靠性在國內外的研究皆已證實與許多傳統檢查不相上下。在加護病房，肺部電阻抗斷層攝影的臨床運用已逐漸普及到評估與調整多種呼吸治療的儀器設定上。在此，我們敘述了如何使用電阻抗斷層攝影，在不插雙腔氣管內管與使用雙側肺獨立通氣的情況下，即時找到最佳吐氣末正壓值，幫助病人成功脫離呼吸器。

並列關鍵字

電阻抗斷層攝影 ； 最佳吐氣末正壓 ； 單側急性肺損傷