Abstract
Electrical impedance tomography (EIT) is an emerging technology for the non-invasive monitoring of regional distribution of ventilation and perfusion, offering real-time and continuous data that can greatly enhance our understanding and management of various respiratory conditions and lung perfusion. Its application may be especially beneficial for critically ill mechanically ventilated patients. Despite its potential, clear evidence of clinical benefits is still lacking, in part due to a lack of standardization and transparent reporting, which is essential for ensuring reproducible research and enhancing the use of EIT for personalized mechanical ventilation. This report is the result of a four-day expert meeting where we aimed to promote the consistent and reliable use of EIT, facilitating its integration into both clinical practice and research, focusing on the adult intensive care patient. We discuss the state-of-the-art regarding EIT acquisition and processing, applications during controlled ventilation and spontaneous breathing, ventilation-perfusion assessment, and novel future directions.
Key Points:
- EIT Technology: Provides real-time, regional imaging of lung ventilation and perfusion, offering insights into conditions like hypoxemia and lung derecruitment.
- Applications: Supports PEEP titration, ventilation-perfusion matching, and identifying mechanical ventilation-induced injuries.
- Acquisition Best Practices: Emphasizes electrode placement, synchronization of signals, and managing artifacts to improve accuracy.
- Challenges: Signal interference, calibration inconsistencies, and lack of standardized reporting hinder widespread adoption.
- Advanced Capabilities: Emerging techniques like 3D-EIT and machine learning could enhance data accuracy and clinical interpretation.
- PEEP Optimization: EIT-guided PEEP titration minimizes overdistension and collapse, contributing to lung-protective ventilation strategies.
- Spontaneous Breathing Monitoring: EIT helps evaluate tidal volume distribution and pendelluft, informing weaning decisions and extubation readiness.
- Ventilation-Perfusion (V/Q) Matching: EIT facilitates bedside assessment of V/Q ratios, aiding in diagnosing gas exchange abnormalities.
- Standardization Needs: Proposes a minimum standard for EIT reporting to ensure reproducibility and comparability of clinical findings.
- Future Directions: Development of multi-frequency devices, better differentiation of tissue properties, and real-time decision-support tools.
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