Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas.
Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas.
Semin Thorac Cardiovasc Surg. 2020;32(2):357-366. doi: 10.1053/j.semtcvs.2019.10.004. Epub 2019 Oct 11.
In patients with alveolar-to-pleural air leak due to recent surgery or trauma, clinicians tend to manage chest tubes with suction therapy. Nonsuction therapy is associated with shorter chest tube duration but also a higher risk of pneumothorax. We sought to develop an intrapleural electrical impedance sensor for continuous, real-time monitoring of pneumothorax development in a porcine model of air leak as a means of promoting nonsuction therapy. Using thoracoscopy, 2 chest tubes and the pleural impedance sensor were introduced into the pleural space of 3 pigs. Continuous air leak was introduced through 1 chest tube by carbon dioxide insufflation. The second chest tube was placed to suction then transitioned to no suction at increasingly higher air leaks until pneumothorax developed. Simultaneously, real-time impedance measurements were obtained from the pleural sensor. Fluoroscopy spot images were captured to verify the presence or absence of pneumothorax. Statistical Analysis Software was used throughout. With the chest tube on suction, a fully expanded lung was identified by a distinct pleural electrical impedance respiratory waveform. With transition of the chest tube to water seal, loss of contact of the sensor with the lung resulted in an immediate measurement of infinite electrical impedance. Pneumothorax resolution by restoring suction therapy was detected in real time by a return of the normal respiratory impedance waveform. Pleural electrical impedance monitoring detected pneumothorax development and resolution in real time. This simple technology has the potential to improve the safety and quality of chest tube management.
在因近期手术或创伤导致的肺泡-胸膜空气漏患者中，临床医生倾向于使用带吸引治疗的胸腔引流管进行管理。非吸引治疗与胸腔引流管持续时间较短相关，但气胸风险也更高。我们试图开发一种胸膜内电阻抗传感器，用于实时监测猪模型中空气漏的气胸发展情况，以此促进非吸引治疗。通过胸腔镜，将 2 根胸腔引流管和胸膜阻抗传感器引入 3 只猪的胸膜腔。通过二氧化碳充气向 1 根胸腔引流管持续引入空气漏。将第 2 根胸腔引流管置于吸引状态，然后逐渐过渡到更高的空气漏，直到发生气胸。同时，从胸膜传感器获得实时阻抗测量值。透视点图像用于验证气胸的存在或不存在。整个过程都使用了统计分析软件。在胸腔引流管处于吸引状态时，肺部完全扩张会产生明显的胸膜电阻抗呼吸波。当胸腔引流管转换为水封时，传感器与肺的接触丢失会导致即时测量出无限电阻抗。通过恢复吸引治疗，气胸的缓解可以实时检测到，正常的呼吸阻抗波形会恢复。胸膜电阻抗监测可实时检测气胸的发生和缓解。这项简单的技术有潜力提高胸腔引流管管理的安全性和质量。
