Monitoring of lobectomy in cystic fibrosis with electrical impedance tomography – a new diagnostic tool

Abstract

Electrical impedance tomography (EIT) is a radiation-free technique generating cross-sectional images of the lung. EIT visualizes global and regional ventilation by illustrating the distribution of electrical bioimpedance. With an electrode belt around the patient's thorax, rotating injection-couples of a harmless alternating current allow voltage measurement of the remaining electrodes. This enables the reconstruction of a tomogram with highly dynamic changes within ventilation. We report on a female six-year-old patient with cystic fibrosis and complete destruction of the upper and middle lobe of the right lung. Lobectomy, a rare therapeutic option in patients with cystic fibrosis that needs to be considered in cases of severe localized destruction, was performed. We show a pre- and postoperative documentation of static (radiology) and dynamic investigation tools (spirometry) in correlation with EIT as a new non-invasive and radiation-free diagnostic tool for this patient group.

Electrical impedance tomography as possible guidance for individual positioning of patients with multiple lung injury

“…In our pediatric patient, lobectomy of the two lobes of the right lung explains the overwhelming ventilation of the left lung. However, as reported by others, an increase of the residual lung after lobectomy due to overinflation and alveolarization was also documented in our patient . This was shown on X‐ray with an expansion of the right lower lobe despite a small apical pneumonectomy cavity.…”

“…EIT was performed in a female pediatric patient (aged 7.5 years) with cystic fibrosis and respiratory failure due to abdominal sepsis caused by Clostridium difficile infection. Twelve months earlier, she underwent lobectomy of the right upper and middle lobe for destruction, cavernous formation and recurrence of infective exacerbations . After resuscitation, the patient was mechanically ventilated for 4 days when EIT measurement was initiated.…”

“…Even in healthy persons, the distribution of air is non‐homogenous within the lung and generally worsens in patients with lung injury such as infiltration, atelectasis, pleural effusion, overinflation and acute respiratory distress syndrome (ARDS) requiring mechanical ventilation . Another cause of lung inhomogeneity is lobectomy, resulting in quantitative and qualitative changes of aeration . In early childhood, lobectomy is mostly associated with a regain of lung volume due to progressive alveolarization, but also with over inflation of the residual lung .…”

Evaluation of surrogate measures of pulmonary function derived from electrical impedance tomography data in children with cystic fibrosis

“…EIT-derived measures of pulmonary inhomogeneity have been used in studies with a small number of CF patients to study regional lung function [22, 23, 24], multi-layer ventilation [25], regional airway obstruction [26], the effect of different breathing aids [27], and monitoring of lobectomy [28]. Differences between the maximal changes in the pulsatile and ventilation impedance signals during intervals of spontaneous breathing have been detected in CF patients versus controls [29].…”

Regional lung function in nonsmokers and asymptomatic current and former smokers

“…The majority of the existing EIT studies on ventilation distribution focus on mechanically ventilated intensive care patients [14,[28][29][30]. We believe that EIT chest examinations may be beneficial in spontaneously breathing patients with pulmonary diseases like COPD, [6,31] asthma [12,13,32] or cystic fibrosis [11,33,34] as well and that this new functional method has a potential in pneumology.…”