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Br J Anaesth. 2019 May 31. pii: S0007-0912(19)30367-8. doi: 10.1016/j.bja.2019.04.056. [Epub ahead of print]

Measurement of relative lung perfusion with electrical impedance and positron emission tomography: an experimental comparative study.

Author information

1
Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
2
Institute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany.
3
Drägerwerk AG & Co. KGaA, Lübeck, Germany.
4
Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy.
5
Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; IRCCS AOU San Martino IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
6
Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Dresden, Germany.
7
Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Electronic address: mgabreu@uniklinikum-dresden.de.

Abstract

BACKGROUND:

Electrical impedance tomography (EIT) with indicator dilution may be clinically useful to measure relative lung perfusion, but there is limited information on the performance of this technique.

METHODS:

Thirteen pigs (50-66 kg) were anaesthetised and mechanically ventilated. Sequential changes in ventilation were made: (i) right-lung ventilation with left-lung collapse, (ii) two-lung ventilation with optimised PEEP, (iii) two-lung ventilation with zero PEEP after saline lung lavage, (iv) two-lung ventilation with maximum PEEP (20/25 cm H2O to achieve peak airway pressure 45 cm H2O), and (v) two-lung ventilation under unilateral pulmonary artery occlusion. Relative lung perfusion was assessed with EIT and central venous injection of saline 3%, 5%, and 10% (10 ml) during breath holds. Relative perfusion was determined by positron emission tomography (PET) using 68Gallium-labelled microspheres. EIT and PET were compared in eight regions of equal ventro-dorsal height (right, left, ventral, mid-ventral, mid-dorsal, and dorsal), and directional changes in regional perfusion were determined.

RESULTS:

Differences between methods were relatively small (95% of values differed by less than 8.7%, 8.9%, and 9.5% for saline 10%, 5%, and 3%, respectively). Compared with PET, EIT underestimated relative perfusion in dependent, and overestimated it in non-dependent, regions. EIT and PET detected the same direction of change in relative lung perfusion in 68.9-95.9% of measurements.

CONCLUSIONS:

The agreement between EIT and PET for measuring and tracking changes of relative lung perfusion was satisfactory for clinical purposes. Indicator-based EIT may prove useful for measuring pulmonary perfusion at bedside.

KEYWORDS:

electrical impedance tomography; indicator dilution; positron emission tomography; regional pulmonary perfusion

PMID:
31160064
DOI:
10.1016/j.bja.2019.04.056

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