A spiky pattern in the course of electrical thoracic impedance as a very early sign of a developing pneumothorax

Summary A pneumothorax ( PTX ) is a potentially lethal condition in high‐risk intensive care patients. Electrical impedance tomography ( EIT ) has been proven to detect PTX at the bedside. A so far not described pattern in the course of thoracic impedance at an early state of PTX was observed in a pig model of ventilator‐induced lung injury ( VILI ) used for a more extensive study. EIT was performed at a framerate of 50 Hz. Beginning of PTX at normal ventilation, manifestation of PTX at VILI ventilation (plateau pressure 42 cm H 2 O) and final pleural drainage were documented. At ventilation with 8·6 ml kg −1 , early PTX findings prior to any clinical deterioration consisted in a spike‐like pattern in the time course of impedance (relative impedance change referred to initial end‐expiratory level). Spike amplitudes (mean ±  SD ) were the following: 0·154 ± 0·059 (right lung) and 0·048 ± 0·050 (left lung). At this state, end‐expiratory levels (mean ±  SD ) were still similar, −0·035 ± 0·010 (right) and −0·058 ± 0·022 (left). After application of VILI ventilation (38 ml kg −1 ), a PTX developed slowly, being confirmed by a continuous increase in the end‐expiratory level on the right side and diverging levels of +0·320 ± 0·057 (right) and −0·193 ± 0·147 (left) at full manifestation. We assume that spikes reflect a temporary change in the electrical pathway caused by leakage into the pleural cavity. This newly described phenomenon of spikes is considered to be a potentially useful indicator for a very early detection of an evolving PTX in high‐risk ICU patients.