Bedside electrical impedance tomography in early diagnosis of pneumothorax in mechanically ventilated ICU patients - a single-center retrospective cohort study.

ABSTRACT

PURPOSE: This study aimed to evaluate the routine use of electrical impedance tomography (EIT) to diagnose pneumothorax (PTX) in mechanically ventilated patients in the intensive care unit (ICU). METHODS: A retrospective cohort study was conducted including mechanically ventilated supine patients who received EIT examinations. The EIT-based tidal variation was divided into ventral and dorsal regions of interest (ROIs) upper right (UR, ROI1), upper left (UL, ROI2) lower right (LR, ROI3), and lower left (LL, ROI4), and the ventilation defect score (DS) was calculated in each quadrant. Furthermore, horizontal ventral ventilation index (HVVI) was defined as ROI1% / ROI2% in the two ventral quadrants if ROI1% > ROI2%, otherwise HVVI = ROI2% / ROI1%. RESULTS: A total of 203 patients were included, 25 of them with confirmed PTX. In the PTX patients, preceding cardiac surgery was the most common cause of PTX. Compared with the patients without PTX, the PTX patients had a higher DS in the ventral quadrants [median and interquartile range (IQR) 1.00 (0.00, 2.00) vs. 0.00 (0.00, 0.00), P < 0.001] respectively, but similar in the dorsal quadrants [median and IQR 1.00 (0.00, 1.00) vs. 0.00 (0.00, 1.00), P = 0.722]. Moreover, a higher HVVI was found in the PTX group [median and IQR 2.51 (1.58, 3.52) vs. 1.36 (1.15, 1.77), P < 0.001]. The area under the receiver operating characteristic curve of the HVVI to differentiate PTX from non-PTX was 0.88, with a sensitivity of 70% and a specificity of 90% when the cut-off value was 2.57. CONCLUSION: The ventilation defect in the ventral regions and a high HVVI on EIT were observed in mechanically ventilated patients with PTX, which should trigger further diagnostics to confirm it.