Evaluation of Different Contrast Agents for Regional Lung Perfusion Measurement Using Electrical Impedance Tomography: An Experimental Pilot Study

Abstract

Monitoring regional blood flow distribution in the lungs appears to be useful for individually optimizing ventilation therapy. Electrical impedance tomography (EIT) can be used at the bedside for indicator-based regional lung perfusion measurement. Hypertonic saline is widely used as a contrast agent but could be problematic for clinical use due to potential side effects. In five ventilated healthy pigs, we investigated the suitability of five different injectable and clinically approved solutions as contrast agents for EIT-based lung perfusion measurement. Signal extraction success rate, signal strength, and image quality were analyzed after repeated 10 mL bolus injections during temporary apnea. The best results were obtained using NaCl 5.85% and sodium-bicarbonate 8.4% with optimal success rates (100%, each), the highest signal strengths (100 ± 25% and 64 ± 17%), and image qualities (r = 0.98 ± 0.02 and 0.95 ± 0.07). Iomeprol 400 mg/mL (non-ionic iodinated X-ray contrast medium) and Glucose 5% (non-ionic glucose solution) resulted in mostly well usable signals with above average success rates (87% and 89%), acceptable signal strength (32 ± 8% and 16 + 3%), and sufficient image qualities (r = 0.80 ± 0.19 and 0.72 ± 0.21). Isotonic balanced crystalloid solution failed due to a poor success rate (42%), low signal strength (10 ± 4%), and image quality (r = 0.43 ± 0.28). While Iomeprol might enable simultaneous EIT and X-ray measurements, glucose might help to avoid sodium and chloride overload. Further research should address optimal doses to balance reliability and potential side effects.