Monitoring postoperative lung recovery using electrical impedance tomography in post anesthesia care unit: an observational study

Nadine Hochhausen, Torsten Kapell, Martin Dürbaum, Andreas Follmann, Rolf Rossaint, Michael Czaplik, Nadine Hochhausen, Torsten Kapell, Martin Dürbaum, Andreas Follmann, Rolf Rossaint, Michael Czaplik

Abstract

With electrical impedance tomography (EIT) recruitment and de-recruitment phenomena can be quantified and monitored at bedside. The aim was to examine the feasibility of EIT with respect to monitor atelectasis formation and resolution in the post anesthesia care unit (PACU). In this observational study, 107 postoperative patients were investigated regarding the presence and recovery of atelectasis described by the EIT-derived parameters Global Inhomogeneity Index (GI Index), tidal impedance variation (TIV), and the changes in end-expiratory lung impedance (ΔEELI). We examined whether the presence of obesity (ADP group) has an influence on pulmonary recovery compared to normal weight patients (NWP group). During the stay at PACU, measurements were taken every 15 min. GI Index, TIV, and ΔEELI were calculated for each time point. 107 patients were monitored and EIT-data of 16 patients were excluded for various reasons. EIT-data of 91 patients were analyzed off-line. Their length of stay averaged 80 min (25th and 75th quartile 52-112). The ADP group demonstrated a significantly higher GI Index at PACU arrival (p < 0.001). This finding disappeared during their stay at the PACU. Additionally, the ADP group showed a significant increase in ΔEELI between PACU arrival and discharge (p = 0.025). Furthermore, TIV showed a significantly lower value during the first 90 min of PACU stay as compared to the time period thereafter (p = 0.036). Our findings demonstrate that obesity has an influence on intraoperative atelectasis formation and de-recruitment during PACU stay. The application of EIT in spontaneously breathing PACU patients seems meaningful in monitoring pulmonary recovery.

Keywords: Electrical impedance tomography; Lung; Pulmonary atelectasis; Recovery room.

Conflict of interest statement

The authors have no conflicts of interest to declare that are relevant to the content of this article.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Global Inhomogeneity Index (GI Index) at arrival to and discharge from the post anesthesia care unit (PACU). The box plot shows the GI Index at admission and discharge from the PACU. At admission, there is a significant difference between obese (ADP group; white) and normal weight patients (NWP group; grey). At discharge, this difference is no longer visible
Fig. 2
Fig. 2
End-expiratory lung impedance (ΔEELI) at discharge from the post anesthesia care unit (PACU). The box plot shows the ΔEELI at discharge from the PACU. During PACU stay, the obese patients (ADP group; white) showed a significant increase in ΔEELI between PACU arrival and discharge. In normal weight patients (NWP group; grey), no significant change occurred.
Fig. 3
Fig. 3
Tidal impedance variation (TIV) at different time periods.The box plot shows the statistical difference of the TIV comparing the first time period (0–75 min) to the second time period (90–180 min) in obese patients (ADP group; white). In normal weight patients (NWP group; grey), no significant change occurred

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