Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic.
Department of Anesthesiology, Resuscitation and Intensive Care Medicine First Faculty of Medicine, The Military University Hospital Prague, Charles University, 121 08 Prague, Czech Republic.
Sensors (Basel). 2023 Oct 23;23(20):8644. doi: 10.3390/s23208644.
Laparoscopic surgery with capnoperitoneum brings many advantages to patients, but also emphasizes the negative impact of anesthesia and mechanical ventilation on the lungs. Even though many studies use electrical impedance tomography (EIT) for lung monitoring during these surgeries, it is not clear what the best position of the electrode belt on the patient's thorax is, considering the cranial shift of the diaphragm. We monitored 16 patients undergoing a laparoscopic surgery with capnoperitoneum using EIT with two independent electrode belts at different tomographic levels: in the standard position of the 4th-6th intercostal space, as recommended by the manufacturer, and in a more cranial position at the level of the axilla. Functional residual capacity (FRC) was measured, and a recruitment maneuver was performed at the end of the procedure by raising the positive end-expiratory pressure (PEEP) by 5 cmHO. The results based on the spectral analysis of the EIT signal show that the ventilation-related impedance changes are not detectable by the belt in the standard position. In general, the cranial belt position might be more suitable for the lung monitoring during the capnoperitoneum since the ventilation signal remains dominant in the obtained impedance waveform. FRC was significantly decreased by the capnoperitoneum and remained lower also after desufflation.
气腹腹腔镜手术给患者带来了许多益处，但也强调了麻醉和机械通气对肺部的负面影响。尽管许多研究在这些手术中使用了电阻抗断层成像（EIT）进行肺部监测，但考虑到膈肌的颅向移位，尚不清楚在患者胸部放置电极带的最佳位置，我们使用 EIT 监测了 16 例接受气腹腹腔镜手术的患者，使用了两个独立的电极带，分别位于不同的断层水平：制造商推荐的第 4-6 肋间隙的标准位置，以及腋窝水平的更颅向位置。测量了功能残气量（FRC），并在手术结束时通过将呼气末正压（PEEP）升高 5 cmH2O 来进行募集操作。基于 EIT 信号的频谱分析结果表明，标准位置的带无法检测到与通气相关的阻抗变化。总的来说，颅向带位置可能更适合气腹期间的肺部监测，因为在获得的阻抗波形中，通气信号仍然占主导地位。气腹会显著降低 FRC，即使在放气后，FRC 也仍然较低。
