therefore, information gathered by EIT has a limited external validity for the remaining lung tissue. However, placing the EIT belt at a higher position is known to reduce the probability to detect inhomogeneity of the lungs at decreasing PEEP levels and, thus, http://www.selleckchem.com/products/Enzastaurin.html the probability to detect lung areas susceptible to the development of VILI. Therefore, we placed the EIT belt just above the diaphragm to increase the probability of detecting lung collapse. Second, based on the protocol of our study described Inhibitors,Modulators,Libraries previously, EIT measurements were not recorded continuously. However, by treating the EIT data as percentages the baseline shifts are corrected. In Inhibitors,Modulators,Libraries addition, the EIT belt was not disconnected from the patient to measure the same lung slice during each measurement.

Third, this study was performed with post cardiac surgery patients who respond well to a recruitment maneuver. However, Reis Miranda et al. demonstrated that a PEEP level of 15 cm H2O was necessary to keep the lung open Inhibitors,Modulators,Libraries in cardiac surgery patients. the authors also showed that if patients are ventilated according to the open lung concept, less cytokines are released, FRC recovers faster, less oxygen is required in the normal ward, and that afterload of the right ventricle is lower in these patients. Despite that adequate PEEP settings are also important in cardiac surgery patients, most patients in need of a recruitment maneuver in combination with best PEEP are ARDS patients. However, ARDS patients show less response to a recruitment maneuver compared with cardiac surgery patients, due to less gravitational dependent infiltrates.

Inhibitors,Modulators,Libraries Particularly in ARDS patients it is important to achieve homogeneous ventilation to reduce the stress acting on lung tissue. Our earlier experimental study showed the same trend of tidal ventilation distribution during a decremental PEEP trial in both ARDS induced and healthy lungs. However, additional studies are required to test whether application of this specific PEEP level leads to better outcome and also to confirm the present findings in patients with ARDS. Conclusion The ITV index was comparable with dynamic compliance to indicate the best PEEP level in post cardiac surgery patients. The intratidal gas distribution is able to identify the onset of overdistention in the non dependent part and recruitment in the dependent part.

We believe that the ITV index may be the ideal bedside tool to detect the best PEEP. however, its preventive effect on VILI and thereby on outcome still needs to be examined in patients Inhibitors,Modulators,Libraries with ALI ARDS. Key messages Several EIT parameters have recently been developed to optimize ventilator settings. Tidal Vandetanib Impedance Variation, regional compliance and ventilation surface area showed different optimal PEEP levels for the dependent and non dependent lung regions.