Ultrasound detection of diaphragm position in the region for lung monitoring by electrical impedance tomography during laparoscopy

Authors: Kristyna Buzkova, Martin Muller, Ales Rara, Karel Roubik, Tomas Tyll

Citation

Buzkova, K., Muller, M., Rara, A., Roubik, K., Tyll, T.: Ultrasound detection of diaphragm position in the region for lung monitoring by electrical impedance tomography during laparoscopy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018 Mar; 162(1): 43-46.

Fulltext in PDF & fulltext download

Download fulltext in PDF here: Ultrasound-detection-of-diaphragm-position-in-the-region-for-lung-monitoring-by-electrical-impedance-tomography-during-laparoscopy.pdf

Published in Biomedical Papers.

Abstract

Background and Aims. During laparoscopic surgery, a capnoperitoneum is created to optimize the operating space for surgeons. One effect of this is abdominal pressure which alters the physiological thoraco-abdominal configuration and pushes the diaphragm and lungs cranially. Since the lung image acquired by electrical impedance tomography (EIT) depends on the conditions within the thorax and abdomen, it is crucial to know the diaphragm position to determine the effect of diaphragm shift on EIT thorax image.

Methods. The presence of diaphragm in the region of EIT measurement was determined by ultrasound in 20 patients undergoing laparoscopic surgery. Data were obtained in the supine position during spontaneous breathing in a me- chanically ventilated patient under general anesthesia with muscle relaxation and in a mechanically ventilated patient under general anesthesia with muscle relaxation during capnoperitoneum.

Results. The diaphragm was shifted cranially during capnoperitoneum. The diaphragm detection rate rose by 10% during capnoperitoneum at the fifth intercostal space, from 55% to 65% and by 10% from 0% at mid-sternal level compared to mechanical ventilation without capnoperitoneum.
Conclusion. The diaphragm was detected in the area contributing to the creation of the thoracic EIT image. Considering the cranial shift of diaphragm caused by excessive intra-abdominal pressure, the impedance changes in the abdomen and the principle of EIT, we assume there could be a significant impact on EIT image of the thorax acquired during capnoperitoneum. For this reason, for lung monitoring using EIT during capnoperitoneum, the manufacturer’s recom- mendation for electrode belt position is not appropriate.

The study was registered in ClinicalTrials.gov with an identifier NCT03038061.

References

[1] Scott-Conner CE, Dawson DL. Operative Anatomy, 3rd ed. Lippincott & Wilkins, Philadelphia; 2009.

[2] Teschner E, Imhoff M. Electrical impedance tomography: The realiza- tion of regional lung monitoring. Dräger Medical GmbH EIT Booklet, Germany, 2011.

[3] Karsten J, Steuber T, Voigt N, Teschner E, Heinze H. Influence of dif- ferent electrode belt positions on electrical impedance tomography imaging of regional ventilation: a prospective observational study. Crit Care 2016;20:3.

[4] Bikker IG, Preis C, Egal M, Bakker J, Gommers D. Electrical impedance tomography measured at two thoracic levels can visualize the ven- tilation distribution changes at the bedside during a decremental positive end-expiratory lung pressure trial. Crit Care 2011;15:R193.

[5] Newell JC, Isaacson D, Cheney M, Saulnier GJ, Gisser DG, Boble JC, Cook RD, Edic PM, Newton CA. In Vivo impedance images using si- nusoidal current patterns. University College London, 1993, Clinical and Physiological Applications of Electrical Impedance Tomography, Chapter Five.

[6] Reifferscheid F, Elke G, Pulletz S, Gawelczyk B, Lautenschläger I, Steinfath M, Weiler N, Frerichs I. Regional ventilation distribution determined by electrical impedance tomography: reproducibility and effects of posture and chest plane. Respirology 2011;16(3):523- 31.

[7] Valenza F, Chevallard G, Fossali T, Salice V, Pizzocri M, Gattinoni L. Management of mechanical ventilation during laparoscopic surgery. Best Pract Res Clin Anaesthesiol 2010;24(2):227-41.

[8] Staehr-Rye AK, Rasmussen LS, Rosenberg J, Steen-Hansen C, Nielsen TF, Rosenstock CV, Clausen HV, Sørensen MK, von H. Regeur J, Gätke MR. Minimal impairment in pulmonary function following laparo- scopic surgery. Acta Anaesthesiol Scand 2014;58:198-205.

[9] Andersson LE, Bååth M, Thörne A, Aspelin P, Odeberg-Wernerman S. Effect of carbon dioxide pneumoperitoneum on development of atelectasis during anesthesia, examined by spiral computed tomog- raphy. Anesthesiology 2005;102(2):293-9.

[10] Joris J, Kaba A, Lamy M. Postoperative spirometry after laparoscopy for lower abdominal or upper abdominal surgical procedures. Br J Anesth 1997;79(4):422-6.

[11] Vlot J, Wijnen R, Stolker RJ, Bax K. Optimizing working space in por- cine laparoscopy: CT measurement of the effects of intra-abdominal pressure. Surg Endosc 2013;27(5):1668-73.

[12] Karsten J, Luepschen H, Grossherr M, Bruch HP, Leonhardt S, Gehring H, Meier T. Effect of PEEP on regional ventilation during laparoscop- ic surgery monitored by electrical impedance tomography. Acta Anaesthesiol Scand 2011;55(7):878-86.

[13] Andersson LE, Bååth M, Thörne A, Aspelin P, Odeberg-Wernerman S. Effect of carbon dioxide pneumoperitoneum on development of atelectasis during anesthesia, examined by spiral computed tomog- raphy. Anesthesiology 2005;102(2):293-9.