Clinical Image
Electrical Impedance Tomography in a Patient With Non-Specific Interstitial Pneumonia
Tomografía de impedancia eléctrica en un paciente con neumonía intersticial no específica
Ana Abella
, Marcela Homez, Isabel Conejo
Corresponding author
Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain
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(B) Increase in ventilated area after ventilatory changes. FR: breathing rate; PCV: pressure-controlled ventilation; PEEP: positive expiratory end pressure: Tinsp: inspiratory time; Vt: tidal volume.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 69-year-old man with a diagnosis of diffuse interstitial lung disease, with a pattern of non-specific interstitial pneumonia. He was admitted to the ICU due to hypoxemic respiratory failure, and began treatment with corticosteroids and cyclophosphamide, and finally required intubation and mechanical ventilation. Static compliance was 10<span class="elsevierStyleHsp" style=""></span>ml/cmH<span class="elsevierStyleInf">2</span>O, and tidal volume had to be set at around 300<span class="elsevierStyleHsp" style=""></span>ml and PEEP at 2<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O to avoid exceeding plateau pressures of 35<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O. No optimal PEEP setting could be found that would achieve recruitment. The patient was monitored using the PulmoVista<span class="elsevierStyleSup">®</span> system (impedance tomography) to evaluate real lack of pulmonary compliance, and to assess ventilatory changes after modifying the respiratory parameters.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The figure shows how only the central part is ventilated on inspiration (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). By increasing the inspiratory time from 1.1<span class="elsevierStyleHsp" style=""></span>s to 1.4<span class="elsevierStyleHsp" style=""></span>s (as well as the other changes indicated in the image), increased ventilation and functional residual capacity could be achieved in the following 24<span class="elsevierStyleHsp" style=""></span>h (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Impedance tomography is a useful technique for the evaluation of situations of complex ventilatory support.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Abella A, Homez M, Conejo I. Tomografía de impedancia eléctrica en un paciente con neumonía intersticial no específica. Arch Bronconeumol. 2017;53:160.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 880 "Ancho" => 3333 "Tamanyo" => 316437 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Only the central part is ventilated. (B) Increase in ventilated area after ventilatory changes. FR: breathing rate; PCV: pressure-controlled ventilation; PEEP: positive expiratory end pressure: Tinsp: inspiratory time; Vt: tidal volume.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tomografía de impedancia eléctrica en la lesión pulmonar aguda" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Riera" 1 => "P.J. Riu" 2 => "P. Casan" 3 => "J.R. Masclans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2011.05.005" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2011" "volumen" => "35" "paginaInicial" => "509" "paginaFinal" => "517" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21680060" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tomografía de impedancia eléctrica pulmonar: funcionamiento, utilidad e imágenes en la práctica clínica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Hermosa Gelbard" 1 => "F. Gordo Vidal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "REMI" "fecha" => "2014" "paginaInicial" => "A197" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005300000003/v1_201703240112/S1579212916303421/v1_201703240112/en/main.assets" "Apartado" => array:4 [ "identificador" => "21342" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical Image" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000003/v1_201703240112/S1579212916303421/v1_201703240112/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916303421?idApp=UINPBA00003Z" ]
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