Regional Ventilation-Perfusion Matching by Electrical Impedance Tomography After Single Lung Transplant

Abstract

Single lung transplantation (LUTX) can be the last therapeutic option for a growing cohort of patients suffering from end-stage respiratory failure. Postoperative ventilatory management of single LUTX recipients is challenged by the coexistence of the diseased native lung and a healthy—but fragile—graft. In this case report, in a single LUTX recipient with idiopathic pulmonary fibrosis, regional ventilation ( ), perfusion ( ), and / matching and subsequent measurement of shunt fraction (Qs/Qt) and alveolar dead space (Vd/Vt) were obtained by integrating electrical impedance tomography (EIT) with volumetric capnography and pulmonary thermodilution technique. Although the preoperative pulmonary scintigraphy showed predominant right lung perfusion (79.8% vs. 20.2%), the EIT documented the postoperative re-establishment of between the lungs (demonstrating the adequate functioning of vascular anastomoses), the diversion of to the graft and similar global Qs/Qt (17%) and Vd/Vt (29%) between native and graft lung. Electrical impedance tomography mapping allowed regional Qs/Qt and Vd/Vt assessment: the native right lung had a completely deranged distribution of and (Qs/Qt 25%, Vd/Vt 46%), whereas the graft showed normal coupling of and (Qs/Qt 8%, Vd/Vt 12%). Electrical impedance tomography may allow noninvasive, repeatable, bedside assessments of the lung / coupling after single LUTX.