Current patterns and electrode types for single-source electrical impedance tomography of the thorax.

Electrical impedance tomography (EIT) estimates the spatial distribution of the electrical tissue properties in a cross section of the body. In the present study, we investigated how the quality of static thoracic images obtained from EIT systems with a single current source and sink is affected by the current pattern employed in the presence of measurement noise. The reconstructed images best reproduced our computational phantom when current source and sink were placed at neighboring electrodes. In this case, the mean squared reconstruction error was an order of magnitude smaller than for all other patterns of current injection studied. At a signal-to-noise ratio of 50 dB, 60% of the reconstructions converged successfully with source and sink at neighboring electrodes, while only 10% or less converged for all other configurations. We relate these results to the fact that neighboring currents strengthen the diagonal structure in the Hessian matrix of the iterative reconstruction process that we employed. We also tested the effects on the reconstruction error of the number and type of electrodes. We found that "compound electrodes" that permit voltage measurement at the site of current injection did not yield any practical improvement of the image quality. In contrast, doubling the number of boundary electrodes reduced the reconstruction error by almost two orders of magnitude.

An adaptive filter to reduce cardiogenic oscillations on esophageal pressure signals.

Measurements of pressure swings in the esophagus (Pes) can be used to estimate variables of clinical importance, e.g., intrinsic positive end-expiratory pressure (PEEPi). Unfortunately, cardiogenic oscillations frequently corrupt Pes and complicate further analysis. Due to significant band overlap with the respiratory component of Pes, cardiogenic oscillations cannot be suppressed adequately using standard filtering techniques. In this article, we present an adaptive filter that employs the electrocardiogram to identify and suppress the cardiogenic oscillations. This filter was tested using simulated data, where the variance accounted for relative to the simulated respiratory pressure swings increased from as low as 55% for the unfiltered Pes signal to over 95% when the adaptive filter was used. In patient data, the adaptive filter reduced the apparent cardiogenic oscillations without noticeably distorting the sharp deflections in Pes due to respiration. Furthermore, the filter suppressed peaks in the Fourier transform of Pes at integer multiples of the heart rate, while the remaining frequencies remained largely unchanged. During stable breathing, the standard deviation of PEEPi was reduced by between 44% and 71% in these four patients when the filter was used. We conclude that our filter removes a significant fraction of the cardiogenic oscillations that corrupt records of Pes.

A model of the spontaneously breathing patient: applications to intrinsic PEEP and work of breathing.

Intrinsic positive end-expiratory pressure (PEEPi) and inspiratory work of breathing (WI) are important factors in the management of severe obstructive respiratory disease. We used a computer model of spontaneously breathing patients with chronic obstructive pulmonary disease to assess the sensitivity of measurement techniques for dynamic PEEPi (PEEPidyn) and WI to expiratory muscle activity (EMA) and cardiogenic oscillations (CGO) on esophageal pressure. Without EMA and CGO, both PEEPidyn and WI were accurately estimated (r = 0.999 and 0.95, respectively). Addition of moderate EMA caused PEEPidyn and WI to be systematically overestimated by 141 and 52%, respectively. Furthermore, CGO introduced large random errors, obliterating the correlation between the true and estimated values for both PEEPidyn (r = 0.29) and WI (r = 0.38). Thus the accurate estimation of PEEPidyn and WI requires steps to be taken to ameliorate the adverse effects of both EMA and CGO. Taking advantage of our simulations, we also investigated the relationship between PEEPidyn and static PEEPi (PEEPistat). The PEEPidyn/PEEPistat ratio decreased as stress adaptation in the lung was increased, suggesting that heterogeneity of expiratory flow limitation is responsible for the discrepancies between PEEPidyn and PEEPistat that have been reported in patients with severe airway obstruction.

Temporal dynamics of acute isovolume bronchoconstriction in the rat.

The time course of lung impedance changes after intravenous injection of bronchial agonist have produced significant insights into the mechanisms of bronchoconstriction in the dog (J. H. T. Bates, A.-M. Lauzon, G. S. Dechman, G. N. Maksym, and T. F. Shuessler. J. Appl. Physiol. 76: 616-626, 1994). We studied the time course of acute induced bronchoconstriction in five anesthetized paralyzed open-chest rats injected intravenously with a bolus of methacholine. For the 16 s immediately after injection, we held the lung volume constant while applying small-amplitude flow oscillations at 1.48, 5.45, and 19.69 Hz simultaneously, which provided us with continuous estimates of lung resistance (RL) and elastance (EL) at each frequency. This procedure was repeated at initial lung inflation pressures of 0.2, 0.4, and 0.6 kPa. Both RL and EL increased progressively after methacholine administration; however, the rate of change of EL increased dramatically as frequency was increased, whereas RL remained relatively independent of frequency. We interpret these findings in terms of a three-compartment model of the rat lung, featuring two parallel alveolar compartments feeding into a central airway compartment. Model simulations support the notions that both central airway shunting and regional ventilation inhomogeneity developed to a significant degree in our constricted rats. We also found that the rates of increase in both RL and EL were greatly enhanced as the initial lung inflation pressure was reduced, in accord with the notion that parenchymal tethering is an important mechanism limiting the extent to which airways can narrow when their smooth muscle is stimulated to contract.

A computer-controlled research ventilator for small animals: design and evaluation.

The understanding of the mechanical properties of the mammalian respiratory system and how they change under the influence of drugs and in disease are frequently pursued in small animals, since they can be easily obtained in large numbers as pure-bred strains. However, conventional experimental set-ups for studying small animals are generally limited in their ability to measure gas flow into the lungs. In this paper, we present a computer-controlled research ventilator for small animals which can provide conventional mechanical ventilation as well as arbitrary flow perturbations with a bandwidth from 0-55 Hz. Respiratory impedance is estimated from the displacement of the piston and the pressure it generates, thereby obviating the need for a direct flow measurement. The performance of the device was tested on mechanical loads whose impedances were calculated theoretically. The measured and predicted loads agreed within less than 5% up to 30 Hz. Furthermore, the measured impedance of two mechanical loads in series precisely matched the sum of their individual impedances.

Temporal dynamics of pulmonary response to intravenous histamine in dogs: effects of dose and lung volume.

We measured tracheal pressure (Ptr) and tracheal flow (V) in open-chest anesthetized paralyzed dogs. The lungs were maintained at a fixed volume (initial positive end-expiratory pressure 0.5 kPa) for 80 s while small-amplitude oscillations in V at 1 and 6 Hz were applied simultaneously at the tracheal opening. A bolus of histamine was given intravenously at the start of the oscillation period. The time course of lung elastic recoil pressure (Pel) was obtained by passing a running average over Ptr to smooth out its oscillations. The oscillations themselves were separated into their 1- and 6-Hz components, as were those in V. By fitting models to the 1- and 6-Hz components of Ptr and V by recursive least squares, we obtained time courses of lung resistance at 6 Hz (RL6), dynamic lung elastance at 1 Hz (EL1), and the difference between dynamic lung resistance at 1 and 6 Hz (RL1-RL6). In four dogs we studied the effects of histamine doses of 0.05, 1.0, and 20 mg. We found that Pel increased quickly and plateaued, RL6 continued to increase throughout the oscillation period, and EL1 exhibited features of both Pel and RL6. Furthermore, the ratio of RL1-RL6 to EL1 was qualitatively similar in time course to Pel. We explain these varied time courses in terms of the development of regional ventilation inhomogeneity throughout the lung as the reaction to histamine develops. In four dogs we also studied the effects of reducing the initial positive end-expiratory pressure by 0.25 kPa and found that the changes in RL6, EL1, and RL1-RL6 were greatly magnified, presumably because of the reduced forces of parenchymal interdependence.