scholarly journals EXPRESS: Rapid dynamic bedside assessment of pulmonary perfusion defect by electrical impedance tomography in a patient with acute massive pulmonary embolism

2020 ◽  
pp. 204589402098404
Author(s):  
Siyi Yuan ◽  
Huaiwu He ◽  
Yun Long ◽  
Yi Chi ◽  
Inéz Frerichs ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Electrical Impedance Tomography ◽  
Perfusion Defect ◽  
Electrical Impedance ◽  
Massive Pulmonary Embolism ◽  
Lung Perfusion ◽  
Regional Perfusion ◽  
Pulmonary Perfusion ◽  
Impedance Tomography ◽  
Regional Lung

Background: Several animal studies have shown that regional lung perfusion could be effectively estimated by the hypertonic saline contrast electrical impedance tomography (EIT) method. Here, we reported an application of this method to dynamically assess regional pulmonary perfusion defect in a patient with acute massive pulmonary embolism. Case presentation: A 68-year-old man experienced sudden dyspnea and cardiac arrest during out-of-bed physical activity on the first day after partial mediastinal tumor resection. Acute pulmonary embolism (PE) was suspected due to acute enlargement of right heart and fixed inferior venous cava measured with bedside ultrasound. The computed tomography pulmonary angiography further confirmed large embolism in both left and right main pulmonary arteries and branches. The regional time impedance curves, which were obtained by a bolus of 10ml 10% NaCl through the central venous catheter, were then analyzed to quantitatively assess regional perfusion. Normal ventilation distribution with massive defects in regional perfusion in both lungs was observed, leading to a ventilation-perfusion mismatch and low oxygenation index (PaO2/FiO2=86 mmHg) at the first day of PE. The anticoagulation was performed with heparin, and the patient’s condition (such as shock, dyspnea, hypoxemia etc.), regional lung perfusion defect and ventilation-perfusion mismatch continuously improved in the following days. Conclusions: This case implies that EIT might have the potential to assess and monitor regional perfusion for rapid diagnosis of fatal PE in clinical practice.

scholarly journals Electrical Impedance Tomography for Cardio-Pulmonary Monitoring

2019 ◽  
Vol 8 (8) ◽  
pp. 1176 ◽  
Author(s):  
Christian Putensen ◽  
Benjamin Hentze ◽  
Stefan Muenster ◽  
Thomas Muders
Keyword(s):  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Lung Perfusion ◽  
Clinical Aspects ◽  
Regional Ventilation ◽  
Impedance Tomography ◽  
Regional Lung ◽  
Lung Overdistension ◽  
Local Ventilation ◽  
Ventilation And Perfusion

Electrical impedance tomography (EIT) is a bedside monitoring tool that noninvasively visualizes local ventilation and arguably lung perfusion distribution. This article reviews and discusses both methodological and clinical aspects of thoracic EIT. Initially, investigators addressed the validation of EIT to measure regional ventilation. Current studies focus mainly on its clinical applications to quantify lung collapse, tidal recruitment, and lung overdistension to titrate positive end-expiratory pressure (PEEP) and tidal volume. In addition, EIT may help to detect pneumothorax. Recent studies evaluated EIT as a tool to measure regional lung perfusion. Indicator-free EIT measurements might be sufficient to continuously measure cardiac stroke volume. The use of a contrast agent such as saline might be required to assess regional lung perfusion. As a result, EIT-based monitoring of regional ventilation and lung perfusion may visualize local ventilation and perfusion matching, which can be helpful in the treatment of patients with acute respiratory distress syndrome (ARDS).

Regional lung perfusion estimated by electrical impedance tomography in a piglet model of lung collapse

2012 ◽  
Vol 112 (1) ◽  
pp. 225-236 ◽  
Author(s):  
João Batista Borges ◽  
Fernando Suarez-Sipmann ◽  
Stephan H. Bohm ◽  
Gerardo Tusman ◽  
Alexandre Melo ◽  
...  
Keyword(s):  
Blood Flow ◽  
Electrical Impedance Tomography ◽  
Pulmonary Blood Flow ◽  
Electrical Impedance ◽  
Lung Perfusion ◽  
Lung Collapse ◽  
Impedance Tomography ◽  
Regional Lung ◽  
First Pass ◽  
Kinetics Of

The assessment of the regional match between alveolar ventilation and perfusion in critically ill patients requires simultaneous measurements of both parameters. Ideally, assessment of lung perfusion should be performed in real-time with an imaging technology that provides, through fast acquisition of sequential images, information about the regional dynamics or regional kinetics of an appropriate tracer. We present a novel electrical impedance tomography (EIT)-based method that quantitatively estimates regional lung perfusion based on first-pass kinetics of a bolus of hypertonic saline contrast. Pulmonary blood flow was measured in six piglets during control and unilateral or bilateral lung collapse conditions. The first-pass kinetics method showed good agreement with the estimates obtained by single-photon-emission computerized tomography (SPECT). The mean difference (SPECT minus EIT) between fractional blood flow to lung areas suffering atelectasis was −0.6%, with a SD of 2.9%. This method outperformed the estimates of lung perfusion based on impedance pulsatility. In conclusion, we describe a novel method based on EIT for estimating regional lung perfusion at the bedside. In both healthy and injured lung conditions, the distribution of pulmonary blood flow as assessed by EIT agreed well with the one obtained by SPECT. The method proposed in this study has the potential to contribute to a better understanding of the behavior of regional perfusion under different lung and therapeutic conditions.

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