DeArmond Daniel T, Das Nitin A, Restrepo Carlos S, Johnson Scott B, Michalek Joel E, Hernandez Brian S
Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
J Surg Res. 2018 Nov;231:15-23. doi: 10.1016/j.jss.2018.05.005. Epub 2018 May 30.
Chest tube management protocols, particularly in patients with alveolar-pleural air leak due to recent surgery or trauma, are limited by concerns over safety, especially concerns about rapid and occult development of pneumothorax. A continuous, real-time monitor of pneumothorax could improve the quality and safety of chest tube management. We developed a rat model of pneumothorax to test a novel approach of measuring electrical impedance within the pleural space as a monitor of lung expansion.
Anesthetized Sprague-Dawley rats underwent right thoracotomy. A novel impedance sensor and a thoracostomy tube were introduced into the right pleural space. Pneumothorax of varying volumes ranging from 0.2 to 20 mL was created by syringe injection of air via the thoracostomy tube. Electrical resistance measurements from the pleural sensor and fluoroscopic images were obtained at baseline and after the creation of pneumothorax and results compared.
A statistically significant, dose-dependent increase in electrical resistance was observed with increasing volume of pneumothorax. Resistance measurement allowed for continuous, real-time monitoring of pneumothorax development and the ability to track pneumothorax resolution by aspiration of air via the thoracostomy tube. Pleural resistance measurement demonstrated 100% sensitivity and specificity for all volumes of pneumothorax tested and was significantly more sensitive for pneumothorax detection than fluoroscopy.
The electrical impedance-based pleural space sensor described in this study provided sensitive and specific pneumothorax detection, which was superior to radiographic analysis. Real-time, continuous monitoring for pneumothorax has the potential to improve the safety, quality, and efficiency of postoperative chest tube management.
胸管管理方案，尤其是在因近期手术或创伤导致肺泡-胸膜漏气的患者中，受到安全性问题的限制，特别是对气胸快速隐匿发展的担忧。对气胸进行连续、实时监测可提高胸管管理的质量和安全性。我们建立了一个气胸大鼠模型，以测试一种测量胸膜腔内电阻抗作为肺扩张监测手段的新方法。
对麻醉后的Sprague-Dawley大鼠进行右胸切开术。将一种新型阻抗传感器和一根胸造瘘管引入右侧胸膜腔。通过经胸造瘘管注射空气，制造出体积从0.2到20 mL不等的气胸。在基线时以及制造气胸后，获取胸膜传感器的电阻测量值和荧光透视图像，并对结果进行比较。
随着气胸体积的增加，观察到电阻有统计学意义的剂量依赖性增加。电阻测量能够对气胸的发展进行连续、实时监测，并能通过经胸造瘘管抽吸空气来追踪气胸的消退情况。胸膜电阻测量对所有测试体积的气胸均显示出100%的敏感性和特异性，并且在检测气胸方面比荧光透视更为敏感。
本研究中描述的基于电阻抗的胸膜腔传感器提供了灵敏且特异的气胸检测，优于影像学分析。对气胸进行实时、连续监测有可能提高术后胸管管理的安全性、质量和效率。
