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HOME > Acute Crit Care > Volume 37(4); 2022 > Article
Images in Critical Care
Pulmonary Real-time distinct visualization of barotrauma risk monitored by electrical impedance tomography in a COVID-19 and latent tuberculosis case
Wagner Souza Leiteorcid, Shirley Lima Camposorcid, Daniella Cunha Brandãoorcid, Caio César Araújo Moraisorcid, Armèle Dornelas de Andradeorcid
Acute and Critical Care 2022;37(4):672-673.
DOI: https://doi.org/10.4266/acc.2022.00920
Published online: September 21, 2022

Department of Physiotherapy, Universidade Federal de Pernambuco, Recife, Brazil

Corresponding author: Wagner Souza Leite Health Applied Biology Graduate Program, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife/PE, 50670-901, Brazil Tel: +55-81-982442798, E-mail: wagner.sleite@ufpe.br
• Received: July 26, 2022   • Revised: August 1, 2022   • Accepted: August 1, 2022

Copyright © 2022 The Korean Society of Critical Care Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A 50-year-old man tested positive for coronavirus disease 2019 (COVID-19) with a medical history of a 3-year-old untreated pulmonary tuberculosis required mechanical ventilation (inspiratory pressure of 15 cm H2O) and electrical impedance tomography (EIT) monitoring. His chest radiograph shows cavitation present in the upper right lobe, which is one of the features of post-primary tuberculosis infection, and a COVID-19 coinfection may facilitate the risk for barotrauma due to its inhomogeneous parenchyma the additional maldistribution of mechanical-ventilator stress (Figure 1) [1-3]. EIT showed a heterogeneous lung volume between anterior-right (cavitation side) and anterior-left (control side) lobes among three positive end-expiratory pressure (PEEP) levels (Figure 1). The EIT functional image shows (1) a progressive lung volume reduction as end-expiratory lung volume increases leading to a greater compression of gas and a resulting potential overdistension, and (2) an ascending volume difference between both half lobes (the blue and red waveforms are overlapped at the lowest PEEP level, and their gap widens as the end-expiratory lung volume increases). There is a lower recruitment/overdistension ratio for the anterior-right at the last PEEP level and this ratio difference increases by PEEP change. The elastic component may be limited by the cavitation and a local stretch exacerbated by the PEEP change presenting a high risk of barotrauma.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

FUNDING

None.

ACKNOWLEDGMENTS

Funding for this project was provided by Universidade Federal de Pernambuco/PROPESQI/PROPG, CAPES CODE 001, CNPq (GRANT 403341/2020-5 and 421756/2021-7) and FACEPE (APQ-0249-4.08/20 and APQ 0801-4.08/21).

AUTHOR CONTRIBUTIONS

Conceptualization: CCAM, SLC. Data curation: WSL. Formal analysis: WSL. Funding acquisition: SLC, DCB, ADA. Methodology: CCAM, WSL. Project administration: SLC, DCB, ADA. Visualization: CCAM, WSL. Writing–original draft: WSL. Writing–review & editing: all authors.

Figure 1.
(A) Chest X-ray shows the cavitation sign at the anterior-right region. (B) Electrical impedance tomography (EIT) functional image shows the ventilation distribution in four regions (right [R], left [L], anterior [A], and posterior [P]). (C) Waveforms plot of lung volume for anterior-left (red) and anterior-right (blue) regions and airway pressure (inspiratory pressure 15 cm H2O plus positive end-expiratory pressure of 10 cm H2O, 15 cm H2O, and 20 cm H2O).
acc-2022-00920f1.jpg
  • 1. Muñoz L, Stagg HR, Abubakar I. Diagnosis and management of latent tuberculosis infection. Cold Spring Harb Perspect Med 2015;5:a017830. ArticlePubMedPMC
  • 2. World Health Organization. Global tuberculosis report 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2022 Jul 12]. Available from: https://www.who.int/publications/i/item/9789240013131.
  • 3. Tofigh AM, Shojaei S, Bagherpour JZ, Mirkheshti A, Tahmasebi H. Subcutaneous emphysema as an ominous side effect in COVID-19 patients under mechanical ventilation, report of 7 cases. J Cell Mol Anesth 2020;5:202-5.Article

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    • Clinical Applicability of Electrical Impedance Tomography in Patient-Tailored Ventilation: A Narrative Review
      Serge J. H. Heines, Tobias H. Becher, Iwan C. C. van der Horst, Dennis C. J. J. Bergmans
      Tomography.2023; 9(5): 1903.     CrossRef

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      Real-time distinct visualization of barotrauma risk monitored by electrical impedance tomography in a COVID-19 and latent tuberculosis case
      Acute Crit Care. 2022;37(4):672-673.   Published online September 21, 2022
      DOI: https://doi.org/10.4266/acc.2022.00920
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