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Rapid dynamic bedside assessment of pulmonary perfusion defect by electrical impedance tomography in a patient with acute massive pulmonary embolism

机译：急性大规模肺栓塞患者电阻抗断层扫描的快速动态床头算法

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Several animal studies have shown that regional lung perfusion could be effectively estimated by the hypertonic saline contrast electrical impedance tomography method. Here, we reported an application of this method to dynamically assess regional pulmonary perfusion defect in a patient with acute massive pulmonary embolism. A 68-year-old man experienced sudden dyspnea and cardiac arrest during out-of-bed physical activity on the first day after partial mediastinal tumor resection. Acute pulmonary embolism was suspected due to acute enlargement of right heart and fixed inferior venous cava measured with bedside ultrasound. The computed tomography pulmonary angiography further confirmed large embolism in both left and right main pulmonary arteries and branches. The regional time impedance curves, which were obtained by a bolus of 10 ml 10% NaCl through the central venous catheter, were then analyzed to quantitatively assess regional perfusion. Normal ventilation distribution with massive defects in regional perfusion in both lungs was observed, leading to a ventilation–perfusion mismatch and low oxygenation index (PaO 2 /FiO2?=?86 mmHg) at the first day of pulmonary embolism. The anticoagulation was performed with heparin, and the patient’s condition (such as shock, dyspnea, hypoxemia, etc.), regional lung perfusion defect, and ventilation–perfusion mismatch continuously improved in the following days. In conclusion, this case implies that electrical impedance tomography might have the potential to assess and monitor regional perfusion for rapid diagnosis of fatal pulmonary embolism in clinical practice.
机译：几种动物研究表明，通过高渗盐水对比电阻断层扫描方法可以有效地估算区域肺灌注。在这里，我们报道了这种方法的应用，以动态评估患者患者患者的肺灌注缺陷。一名68岁的男子在部分纵隔肿瘤切除后的第一天在床上的身体活动中经历了突发的呼吸困难和心脏骤停。由于右心的急性扩大，并且用床边超声测量的固定下静脉CAVA而怀疑急性肺栓塞。计算机断层摄影肺血管造影进一步证实了左右主要肺动脉和分支中的大型栓塞。然后通过中央静脉导管通过10mL 10％NaCl的推注获得的区域时间阻抗曲线，以定量评估区域灌注。在肺栓塞的第一天，观察到两种肺部在两种肺部灌注中具有大规模缺陷的正常通风分布，导致通风 - 灌注失配和低氧合指数（Pao 2 / FiO 2？= 86mmHg）。抗凝血用肝素进行，患者的病症（如休克，呼吸困难，低氧血症等），区域肺灌注缺陷和通风 - 灌注错配在后续的日期中不断改进。总之，这种情况表明，电阻抗断层扫描可能有可能评估和监测区域灌注，以便在临床实践中快速诊断致命肺栓塞。

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