A spiky pattern in the course of electrical thoracic impedance as a very early sign of a developing pneumothorax.

Abstract

A pneumothorax (PTX) is a potentially lethal condition in high-risk intensive care patients. Electrical impedance tomography (EIT) has been proven to detect PTX at the bedside. A so far not described pattern in the course of thoracic impedance at an early state of PTX was observed in a pig model of ventilator-induced lung injury (VILI) used for a more extensive study. EIT was performed at a framerate of 50Hz. Beginning of PTX at normal ventilation, manifestation of PTX at VILI ventilation (plateau pressure 42cm H2 O) and final pleural drainage were documented. At ventilation with 8·6mlkg-1 , early PTX findings prior to any clinical deterioration consisted in a spike-like pattern in the time course of impedance (relative impedance change referred to initial end-expiratory level). Spike amplitudes (mean±SD) were the following: 0·154±0·059 (right lung) and 0·048±0·050 (left lung). At this state, end-expiratory levels (mean±SD) were still similar, -0·035±0·010 (right) and -0·058±0·022 (left). After application of VILI ventilation (38mlkg-1 ), a PTX developed slowly, being confirmed by a continuous increase in the end-expiratory level on the right side and diverging levels of +0·320±0·057 (right) and -0·193±0·147 (left) at full manifestation. We assume that spikes reflect a temporary change in the electrical pathway caused by leakage into the pleural cavity. This newly described phenomenon of spikes is considered to be a potentially useful indicator for a very early detection of an evolving PTX in high-risk ICU patients.