Personalized ventilation guided by electrical impedance tomography with increased PEEP improves ventilation‐perfusion matching in asymmetrical airway closure and contralateral pulmonary embolism during veno‐venous extracorporeal membrane oxygenation: A case report
Abstract We report the case of a 54‐year‐old man with right‐lung pneumonia and contralateral pulmonary embolism (PE) conditioning severe refractory hypoxemia requiring veno‐venous extracorporeal membrane oxygenation. Electrical impedance tomography (EIT) was used to assess recruitability and regiona...
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Wiley
2025-04-01
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| Online Access: | https://doi.org/10.14814/phy2.70280 |
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| author | Roberta Garberi Claudio Ripa Gianmarco Carenini Luca Bastia Marco Giani Giuseppe Foti Emanuele Rezoagli |
| author_facet | Roberta Garberi Claudio Ripa Gianmarco Carenini Luca Bastia Marco Giani Giuseppe Foti Emanuele Rezoagli |
| author_sort | Roberta Garberi |
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| description | Abstract We report the case of a 54‐year‐old man with right‐lung pneumonia and contralateral pulmonary embolism (PE) conditioning severe refractory hypoxemia requiring veno‐venous extracorporeal membrane oxygenation. Electrical impedance tomography (EIT) was used to assess recruitability and regional ventilation and perfusion. At a clinical positive‐end expiratory pressure (PEEP) of 12 cmH₂O, EIT revealed predominant ventilation in the left lung and predominant perfusion in the right lung. Reduced perfusion in the left lung raised suspicion of PE, confirmed by contrast‐enhanced computed tomography. The clinical PEEP was insufficient to maintain recruitment of the pneumonia‐affected right lung, which showed an airway opening pressure (AOP) of 16 cmH₂O. Therefore, PEEP was increased to 20 cmH₂O to exceed the AOP of the injured lung, improving lung recruitment, stabilizing end expiratory lung impedance (EELI), and increasing V/Q matching. Oxygenation improved, following an increased cardiac output, and reduced pulmonary vascular resistance. Despite increasing ventilation pressures, the higher PEEP was well‐tolerated hemodynamically, optimizing V/Q coupling in this case of unilateral shunt and contralateral dead space. This case highlights the utility of ventilation/perfusion EIT in optimizing ventilatory strategies, in anticipating the presence of pulmonary malperfusion at bedside, and demonstrating the importance of individualized, physiology‐based interventions in complex critical care scenarios. |
| format | Article |
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| institution | OA Journals |
| issn | 2051-817X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
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| spelling | doaj-art-9224a3ec44ad47a292406e9578fde3aa2025-08-20T02:26:27ZengWileyPhysiological Reports2051-817X2025-04-01137n/an/a10.14814/phy2.70280Personalized ventilation guided by electrical impedance tomography with increased PEEP improves ventilation‐perfusion matching in asymmetrical airway closure and contralateral pulmonary embolism during veno‐venous extracorporeal membrane oxygenation: A case reportRoberta Garberi0Claudio Ripa1Gianmarco Carenini2Luca Bastia3Marco Giani4Giuseppe Foti5Emanuele Rezoagli6School of Medicine and Surgery University of Milano‐Bicocca Monza ItalySchool of Medicine and Surgery University of Milano‐Bicocca Monza ItalySchool of Medicine and Surgery University of Milano‐Bicocca Monza ItalyAnesthesia and Intensive Care Unit AUSL Romagna, M. Bufalini Hospital Cesena ItalySchool of Medicine and Surgery University of Milano‐Bicocca Monza ItalySchool of Medicine and Surgery University of Milano‐Bicocca Monza ItalySchool of Medicine and Surgery University of Milano‐Bicocca Monza ItalyAbstract We report the case of a 54‐year‐old man with right‐lung pneumonia and contralateral pulmonary embolism (PE) conditioning severe refractory hypoxemia requiring veno‐venous extracorporeal membrane oxygenation. Electrical impedance tomography (EIT) was used to assess recruitability and regional ventilation and perfusion. At a clinical positive‐end expiratory pressure (PEEP) of 12 cmH₂O, EIT revealed predominant ventilation in the left lung and predominant perfusion in the right lung. Reduced perfusion in the left lung raised suspicion of PE, confirmed by contrast‐enhanced computed tomography. The clinical PEEP was insufficient to maintain recruitment of the pneumonia‐affected right lung, which showed an airway opening pressure (AOP) of 16 cmH₂O. Therefore, PEEP was increased to 20 cmH₂O to exceed the AOP of the injured lung, improving lung recruitment, stabilizing end expiratory lung impedance (EELI), and increasing V/Q matching. Oxygenation improved, following an increased cardiac output, and reduced pulmonary vascular resistance. Despite increasing ventilation pressures, the higher PEEP was well‐tolerated hemodynamically, optimizing V/Q coupling in this case of unilateral shunt and contralateral dead space. This case highlights the utility of ventilation/perfusion EIT in optimizing ventilatory strategies, in anticipating the presence of pulmonary malperfusion at bedside, and demonstrating the importance of individualized, physiology‐based interventions in complex critical care scenarios.https://doi.org/10.14814/phy2.70280acute respiratory distress syndrome (ARDS)asymmetrical airway closurecase reportelectrical impedance tomography (EIT)pulmonary embolism (PE) |
| spellingShingle | Roberta Garberi Claudio Ripa Gianmarco Carenini Luca Bastia Marco Giani Giuseppe Foti Emanuele Rezoagli Personalized ventilation guided by electrical impedance tomography with increased PEEP improves ventilation‐perfusion matching in asymmetrical airway closure and contralateral pulmonary embolism during veno‐venous extracorporeal membrane oxygenation: A case report Physiological Reports acute respiratory distress syndrome (ARDS) asymmetrical airway closure case report electrical impedance tomography (EIT) pulmonary embolism (PE) |
| title | Personalized ventilation guided by electrical impedance tomography with increased PEEP improves ventilation‐perfusion matching in asymmetrical airway closure and contralateral pulmonary embolism during veno‐venous extracorporeal membrane oxygenation: A case report |
| title_full | Personalized ventilation guided by electrical impedance tomography with increased PEEP improves ventilation‐perfusion matching in asymmetrical airway closure and contralateral pulmonary embolism during veno‐venous extracorporeal membrane oxygenation: A case report |
| title_fullStr | Personalized ventilation guided by electrical impedance tomography with increased PEEP improves ventilation‐perfusion matching in asymmetrical airway closure and contralateral pulmonary embolism during veno‐venous extracorporeal membrane oxygenation: A case report |
| title_full_unstemmed | Personalized ventilation guided by electrical impedance tomography with increased PEEP improves ventilation‐perfusion matching in asymmetrical airway closure and contralateral pulmonary embolism during veno‐venous extracorporeal membrane oxygenation: A case report |
| title_short | Personalized ventilation guided by electrical impedance tomography with increased PEEP improves ventilation‐perfusion matching in asymmetrical airway closure and contralateral pulmonary embolism during veno‐venous extracorporeal membrane oxygenation: A case report |
| title_sort | personalized ventilation guided by electrical impedance tomography with increased peep improves ventilation perfusion matching in asymmetrical airway closure and contralateral pulmonary embolism during veno venous extracorporeal membrane oxygenation a case report |
| topic | acute respiratory distress syndrome (ARDS) asymmetrical airway closure case report electrical impedance tomography (EIT) pulmonary embolism (PE) |
| url | https://doi.org/10.14814/phy2.70280 |
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