MASTER THE LUNG
Timpel Enlight 1800 is a novel, non invasive and radiation-free equipment for bedside assessment of the lung in intensive care units and operating rooms. Providing real-time and intuitive images of ventilation distribution within the lung, it allows prompt diagnosis of lung heterogeneities, like lung collapse, lung overdistension, or asynchronous lung filling. A careful assessment of the potential to reverse lung collapse can be easily obtained. It also allows the quick diagnosis of pneumothorax, selective intubation, or an excessive tidal volume.
Timpel Enlight 1800 is based on Electrical Impedance Tomogfraphy (EIT) technology, in which cross sectional images of the thoracic/lung resistivity are inferred from electrical measurements performed on the thoracic skin, at high sampling rates.
Timpel Enlight 1800 combines an ergonomic electrode belt with a disposable patient interface, a high-end electronic system for image generation, and sophisticated algorithms for physiological interpretation and diagnosis.
Timpel Enlight 1800 is an operator-independent technology, which enhances the diagnostic capabilities of intensivists at the bedside, helping them to:
- individualize patient care,
- protect the lung, and
- prevent complications during mechanical ventilation.
Mechanical Ventilation is a life-saving intervention for patients with acute respiratory failure, applied to more than one third of patients entering the intensive care unit. The procedure, however, exposes patients to complications like ventilator induced lung injury (VILI), pneumothorax, or cardiovascular collapse.
To reduce the risks for such complications, protective ventilation strategies are applied by intensivists, who have to meticulously adjust ventilator settings according to the high demands of critical patients, but at the same time providing some rest for the fragile parenchyma.
Unfortunately, physicians have been taking their decisions based on limited physiologic parameters, such as blood gases and pressure-volume curves, all of them poorly reflecting the complex lung condition. After a few hours of mechanical ventilation, the posterior parts of the lung suffer the compressing effects of gravity and abdominal distension, undergoing progressive collapse. This phenomenon is aggravated by high concentrations of inspired oxygen, or by infections. The lung gets progressively heterogeneous, with its anterior part being forced to receive most of the tidal volume and getting progressively overstretched. All these pathological mechanisms cause lung inflammation and fibrosis, being overlooked by physicians who are limited by the current technological gap in bedside lung monitoring.
Risks of Mechanical Ventilation
More than one third of patients entering the ICU are submitted to mechanical ventilation for more than 12 hours (Esteban et al 2002; Esteban et al. 2008). Forty percent of these patients will die during the hospital stay.
About 24% of patients of those patients with previously healthy lung will develop mild to severe forms of Acute Respiratory Distress Syndrome (ARDS) within the first 5 days of artificial ventilation (Gajic et al. 2004), with a clear association between bad ventilator adjustments and ARDS incidence. ARDS is an inflammatory lung disease that adds extra mortality and longer ICU stay, representing a burden to the healthcare system.
Despite our efforts to protect the lungs, the incidence of barotrauma in patients with ARDS still approaches 6-10%. Bad ventilator settings are clearly related to barotrauma (Boussarsar M et al, 2002). It has been difficult to prove that barotrauma causes death directly, but it is evident that the presence of barotrauma indicates a patient with doubled mortality risk. (Esteban et al. 2004). An emerging hypothesis is that barotrauma marks patients submitted to bad ventilator adjustments or those who have passed through stressful moments in the ICU, which may trigger bad events and dysfunctions after some delay.
Ample literature suggests that protective mechanical ventilation strategies can decrease mortality (Amato et al. 1998; ARDSnetwork 2000) in patients with ARDS, decreasing the length of stay (Mercat et al. 2008), and decreasing the use of rescue therapies (Meade et al. 2008). The overall ARDS mortality, however, still remains around 45% in observational studies (Phua et al. 2009).
Abundant physiological evidence suggests that an additional (and substantial) reduction in mortality may be expected with further optimization of mechanical ventilation. This requires individualization of ventilator settings, especially in patients with severe, heterogeneous lung disease (Terragni et al. 2007).
Without proper lung diagnostic tools or CT scannning at the bedside (Gattinoni et al. 2006), intensivists are blind and lost. Default protocols for lung protection are clearly limited, causing harm in a large proportion of patients (Grasso et al. 2007; Briel et al. 2010)
In this context, the Enlight® technology was created with the explicit goal of providing tools for optimizing and individualizing mechanical ventilation. The concept was to enhance the diagnostic capabilities of intensivists, helping them to take well informed decisions at the bedside. By providing intuitive images of the lung condition, we help them to individualize lung protection.
In a quick assessment that takes less than 5 minutes, physicians can verify the potential for lung recruitment and select PEEP levels minimizing collapse and overdistension, simultaneously. As useful as a radar in a cloudy sky, physicians can now see what is happening inside the patient's lung.