open access

Vol 49, No 3 (2017)
Original and clinical articles
Published online: 2017-08-12
Submitted: 2016-12-23
Accepted: 2017-02-18
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Electrical impedance tomography for diagnosis and monitoring of pulmonary function disorders in the intensive care unit — case report and review of literature

Szymon Białka, Maja Copik, Katarzyna Rybczyk, Hanna Misiołek
DOI: 10.5603/AIT.2017.0040
·
Pubmed: 28803440
·
Anaesthesiol Intensive Ther 2017;49(3):222-226.

open access

Vol 49, No 3 (2017)
Original and clinical articles
Published online: 2017-08-12
Submitted: 2016-12-23
Accepted: 2017-02-18

Abstract

The aim of this paper is to describe the possibility of using Electrical Impedance Tomography (EIT) as a treatment monitoring tool in the ICU. It was based on case report and literature review. A 19-year-old female was admitted to ICU due to severe acute respiratory distress syndrome. Despite aggressive treatment there was no improvement. We decided to use EIT in the monitoring of treatment because of difficulties in transporting the patient to the radiology department in order to perform a control CT scan. After identifying the causing factor (Pneumocyctis jiroveci), EIT monitoring was maintained to assess the effectiveness of targeted microbial treatment. In the following days, we observed an improvement of regional ventilation of the upper and middle segments of the left lung that corresponded well with laboratory test results, especially arterial blood gas analysis. The use of Electrical Impedance Tomography enables non-invasive, bedside, continuous assessment of regional lung ventilation. It is possible to use it in both mechanically ventilated and spontaneously breathing patients. It allows efficient and dynamic monitoring of the course of the therapeutic process. Interpretation of the results is relatively easy to learn and does not require specialist knowledge. Moreover, it is possible to use EIT in those cases where other methods are of high risk or contraindicated.

Abstract

The aim of this paper is to describe the possibility of using Electrical Impedance Tomography (EIT) as a treatment monitoring tool in the ICU. It was based on case report and literature review. A 19-year-old female was admitted to ICU due to severe acute respiratory distress syndrome. Despite aggressive treatment there was no improvement. We decided to use EIT in the monitoring of treatment because of difficulties in transporting the patient to the radiology department in order to perform a control CT scan. After identifying the causing factor (Pneumocyctis jiroveci), EIT monitoring was maintained to assess the effectiveness of targeted microbial treatment. In the following days, we observed an improvement of regional ventilation of the upper and middle segments of the left lung that corresponded well with laboratory test results, especially arterial blood gas analysis. The use of Electrical Impedance Tomography enables non-invasive, bedside, continuous assessment of regional lung ventilation. It is possible to use it in both mechanically ventilated and spontaneously breathing patients. It allows efficient and dynamic monitoring of the course of the therapeutic process. Interpretation of the results is relatively easy to learn and does not require specialist knowledge. Moreover, it is possible to use EIT in those cases where other methods are of high risk or contraindicated.

Get Citation

Keywords

intensive care, monitoring, electrical impedance tomography

About this article
Title

Electrical impedance tomography for diagnosis and monitoring of pulmonary function disorders in the intensive care unit — case report and review of literature

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 49, No 3 (2017)

Pages

222-226

Published online

2017-08-12

DOI

10.5603/AIT.2017.0040

Pubmed

28803440

Bibliographic record

Anaesthesiol Intensive Ther 2017;49(3):222-226.

Keywords

intensive care
monitoring
electrical impedance tomography

Authors

Szymon Białka
Maja Copik
Katarzyna Rybczyk
Hanna Misiołek

References (50)
  1. Puybasset L, Gusman P, Muller JC, et al. Regional distribution of gas and tissue in acute respiratory distress syndrome. III. Consequences for the effects of positive end-expiratory pressure. CT Scan ARDS Study Group. Adult Respiratory Distress Syndrome. Intensive Care Med. 2000; 26(9): 1215–1227.
  2. Gattinoni L, Pesenti A, Bombino M, et al. Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology. 1988; 69(6): 824–832.
  3. Maunder RJ, Shuman WP, McHugh JW, et al. Preservation of normal lung regions in the adult respiratory distress syndrome. Analysis by computed tomography. JAMA. 1986; 255(18): 2463–2465.
  4. Terragni PP, Rosboch G, Tealdi A, et al. Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2007; 175(2): 160–166.
  5. Boissier F, Katsahian S, Razazi K, et al. Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome. Intensive Care Med. 2013; 39(10): 1725–1733.
  6. Lhéritier G, Legras A, Caille A, et al. Prevalence and prognostic value of acute cor pulmonale and patent foramen ovale in ventilated patients with early acute respiratory distress syndrome: a multicenter study. Intensive Care Med. 2013; 39(10): 1734–1742.
  7. Keenan SP, Sinuff T, Burns KEA, et al. Canadian Critical Care Trials Group/Canadian Critical Care Society Noninvasive Ventilation Guidelines Group. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2011; 183(3): E195–E214.
  8. Harris ND, Suggett AJ, Barber DC, et al. Applications of applied potential tomography (APT) in respiratory medicine. Clin Phys Physiol Meas. 1987; 8 Suppl A: 155–165.
  9. Nebuya S, Mills GH, Milnes P, et al. Indirect measurement of lung density and air volume from electrical impedance tomography (EIT) data. Physiol Meas. 2011; 32(12): 1953–1967.
  10. Stankiewicz-Rudnicki M, Gaszyński T, Gaszyński W. Assessment of regional ventilation in acute respiratory distress syndrome by electrical impedance tomography. Anaesthesiol Intensive Ther. 2015; 47(1): 77–81.
  11. Hurst JM, Davis K, Johnson DJ, et al. Cost and complications during in-hospital transport of critically ill patients: a prospective cohort study. J Trauma. 1992; 33(4): 582–585.
  12. Szem JW, Hydo LJ, Fischer E, et al. High-risk intrahospital transport of critically ill patients: safety and outcome of the necessary "road trip". Crit Care Med. 1995; 23(10): 1660–1666.
  13. Indeck M, Peterson S, Smith J, et al. Risk, cost, and benefit of transporting ICU patients for special studies. J Trauma. 1988; 28(7): 1020–1025.
  14. Zanetta G, Robert D, Guérin C. Evaluation of ventilators used during transport of ICU patients -- a bench study. Intensive Care Med. 2002; 28(4): 443–451.
  15. Evans A, Winslow EH. Oxygen saturation and hemodynamic response in critically ill, mechanically ventilated adults during intrahospital transport. Am J Crit Care. 1995; 4(2): 106–111.
  16. Waydhas C, Schneck G, Duswald KH. Deterioration of respiratory function after intra-hospital transport of critically ill surgical patients. Intensive Care Med. 1995; 21(10): 784–789.
  17. Kollef MH, Von Harz B, Prentice D, et al. Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia. Chest. 1997; 112(3): 765–773.
  18. Yang Jx, Zhang M, Liu Zh, et al. Detection of lung atelectasis/consolidation by ultrasound in multiple trauma patients with mechanical ventilation. Critical Ultrasound Journal. 2009; 1(1): 13–16.
  19. Stefanidis K, Dimopoulos S, Tripodaki ES, et al. Lung sonography and recruitment in patients with early acute respiratory distress syndrome: a pilot study. Crit Care. 2011; 15(4): R185.
  20. Frerichs I, Amato MBP, van Kaam AH, et al. TREND study group. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax. 2017; 72(1): 83–93.
  21. Wrigge H, Zinserling J, Muders T, et al. Electrical impedance tomography compared with thoracic computed tomography during a slow inflation maneuver in experimental models of lung injury. Crit Care Med. 2008; 36(3): 903–909.
  22. Frerichs I, Hinz J, Herrmann P, et al. Detection of local lung air content by electrical impedance tomography compared with electron beam CT. J Appl Physiol (1985). 2002; 93(2): 660–666.
  23. Elke G, Fuld MK, Halaweish AF, et al. Quantification of ventilation distribution in regional lung injury by electrical impedance tomography and xenon computed tomography. Physiol Meas. 2013; 34(10): 1303–1318.
  24. Victorino JA, Borges JB, Okamoto VN, et al. Imbalances in regional lung ventilation: a validation study on electrical impedance tomography. Am J Respir Crit Care Med. 2004; 169(7): 791–800.
  25. Hinz J, Neumann P, Dudykevych T, et al. Regional ventilation by electrical impedance tomography: a comparison with ventilation scintigraphy in pigs. Chest. 2003; 124(1): 314–322.
  26. Richard JC, Pouzot C, Gros A, et al. Electrical impedance tomography compared to positron emission tomography for the measurement of regional lung ventilation: an experimental study. Crit Care. 2009; 13(3): R82.
  27. Shi C, Boehme S, Bentley AH, et al. Assessment of regional ventilation distribution: comparison of vibration response imaging (VRI) with electrical impedance tomography (EIT). PLoS One. 2014; 9(1): e86638.
  28. Hinz J, Moerer O, Neumann P, et al. Effect of positive end-expiratory-pressure on regional ventilation in patients with acute lung injury evaluated by electrical impedance tomography. Eur J Anaesthesiol. 2005; 22(11): 817–825.
  29. Coulombe N, Gagnon H, Marquis F, et al. A parametric model of the relationship between EIT and total lung volume. Physiol Meas. 2005; 26(4): 401–411.
  30. Costa ELV, Borges JB, Melo A, et al. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography. Intensive Care Med. 2009; 35(6): 1132–1137.
  31. Karsten J, Grusnick C, Paarmann H, et al. Positive end-expiratory pressure titration at bedside using electrical impedance tomography in post-operative cardiac surgery patients. Acta Anaesthesiol Scand. 2015; 59(6): 723–732.
  32. Blankman P, Hasan D, Erik G, et al. Detection of 'best' positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial. Crit Care. 2014; 18(3): R95.
  33. Odenstedt H, Lindgren S, Olegård C, et al. Slow moderate pressure recruitment maneuver minimizes negative circulatory and lung mechanic side effects: evaluation of recruitment maneuvers using electric impedance tomography. Intensive Care Med. 2005; 31(12): 1706–1714.
  34. Frerichs I, Dargaville PA, Dudykevych T, et al. Electrical impedance tomography: a method for monitoring regional lung aeration and tidal volume distribution? Intensive Care Med. 2003; 29(12): 2312–2316.
  35. Luepschen H, Meier T, Grossherr M, et al. Assessment of regional lung recruitment and derecruitment during a PEEP trial based on electrical impedance tomography. Intensive Care Med. 2008; 34(3): 543–550.
  36. Zick G, Elke G, Becher T, et al. Effect of PEEP and tidal volume on ventilation distribution and end-expiratory lung volume: a prospective experimental animal and pilot clinical study. PLoS One. 2013; 8(8): e72675.
  37. Grychtol B, Elke G, Meybohm P, et al. Functional validation and comparison framework for EIT lung imaging. PLoS One. 2014; 9(8): e103045.
  38. Pulletz S, Kott M, Elke G, et al. Dynamics of regional lung aeration determined by electrical impedance tomography in patients with acute respiratory distress syndrome. Multidiscip Respir Med. 2012; 7(1): 44.
  39. Victorino JA, Borges JB, Okamoto VN, et al. Imbalances in regional lung ventilation: a validation study on electrical impedance tomography. Am J Respir Crit Care Med. 2004; 169(7): 791–800.
  40. Vogt B, Pulletz S, Elke G, et al. Spatial and temporal heterogeneity of regional lung ventilation determined by electrical impedance tomography during pulmonary function testing. J Appl Physiol (1985). 2012; 113(7): 1154–1161.
  41. Frerichs I, Dargaville PA, van Genderingen H, et al. Lung volume recruitment after surfactant administration modifies spatial distribution of ventilation. Am J Respir Crit Care Med. 2006; 174(7): 772–779.
  42. Costa ELV, Chaves CN, Gomes S, et al. Real-time detection of pneumothorax using electrical impedance tomography. Crit Care Med. 2008; 36(4): 1230–1238.
  43. Tingay DG, Copnell B, Grant CA, et al. The effect of endotracheal suction on regional tidal ventilation and end-expiratory lung volume. Intensive Care Med. 2010; 36(5): 888–896.
  44. Pulletz S, Elke G, Zick G, et al. Performance of electrical impedance tomography in detecting regional tidal volumes during one-lung ventilation. Acta Anaesthesiol Scand. 2008; 52(8): 1131–1139.
  45. Frerichs I, Pulletz S, Elke G, et al. Assessment of changes in distribution of lung perfusion by electrical impedance tomography. Respiration. 2009; 77(3): 282–291.
  46. Vonk Noordegraaf A, Kunst PW, Janse A, et al. Pulmonary perfusion measured by means of electrical impedance tomography. Physiol Meas. 1998; 19(2): 263–273.
  47. Li Y, Tesselaar E, Borges JB, et al. Hyperoxia affects the regional pulmonary ventilation/perfusion ratio: an electrical impedance tomography study. Acta Anaesthesiol Scand. 2014; 58(6): 716–725.
  48. Miedema M, de Jongh FH, Frerichs I, et al. Changes in lung volume and ventilation during surfactant treatment in ventilated preterm infants. Am J Respir Crit Care Med. 2011; 184(1): 100–105.
  49. Miedema M, de Jongh FH, Frerichs I, et al. Changes in lung volume and ventilation during lung recruitment in high-frequency ventilated preterm infants with respiratory distress syndrome. J Pediatr. 2011; 159(2): 199–205.e2.
  50. van Veenendaal MB, Miedema M, de Jongh FHC, et al. Effect of closed endotracheal suction in high-frequency ventilated premature infants measured with electrical impedance tomography. Intensive Care Med. 2009; 35(12): 2130–2134.

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