Abstract
Electrical impedance tomography (EIT) is a non-invasive, radiation-free and bedside imaging tool that is widely used for real-time monitoring of lung ventilation. Recently, it has been proposed for use in quantitative assessment of regional lung perfusion with hypertonic saline bolus injection and consequently for pulmonary embolism (PE) detection. Here, we present a case of high-risk PE in a postoperative patient, in which EIT monitoring provided us with useful information for diagnosis and decision-making, especially with the challenge of anticoagulation and risk of bleeding.
Highlights
Pulmonary embolism (PE) is the third most frequent acute cardiovascular syndrome worldwide after myocardial infarction and stroke [1]
Electrical impedance tomography (EIT) was used as a valuable bedside tool for clinical decisionmaking during the management of high-risk PE
The patient was successfully cured of the vital respiratory failure and circulatory shock caused by PE
Summary
Pulmonary embolism (PE) is the third most frequent acute cardiovascular syndrome worldwide after myocardial infarction and stroke [1]. Thrombolysis (alteplase 50 mg) was initiated immediately, three hours after which continuouslyinfused heparin was given to the patient to achieve the activated partial thromboplastin time (APTT) at 50–70 s After thrombolysis, another EIT with hypertonic saline bolus infusion was performed to observe lung perfusion. CTPA revealed that the emboli in the right trunk, right pulmonary artery branches, and left artery branches had decreased in size, and the pulmonary artery was more visualized in the FIGURE 4 | On Day 5, lung ultrasound was performed to find the cause of ventilation defect in the left dorsal lung. The pulmonary perfusion image of EIT revealed homogeneous perfusion in both the left and right lungs, indicating that the pulmonary perfusion of the lung did not worsen without anticoagulation (Figure 1D) Based on this information, we decided to continue closely monitoring the patient’s condition without anticoagulation. The anticoagulation therapy was not restarted until Day 20, and the respiratory condition of the patient remained stable
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