{"id":1451,"date":"2026-03-22T10:51:19","date_gmt":"2026-03-22T10:51:19","guid":{"rendered":"https:\/\/perfusfind.com\/ic\/?p=1451"},"modified":"2026-03-22T10:51:19","modified_gmt":"2026-03-22T10:51:19","slug":"recommendations-for-lung-ventilation-and-perfusion-assessment-with-chest-electrical-impedance-tomography-in-critically-ill-adult-patients","status":"publish","type":"post","link":"https:\/\/perfusfind.com\/ic\/index.php\/2026\/03\/22\/recommendations-for-lung-ventilation-and-perfusion-assessment-with-chest-electrical-impedance-tomography-in-critically-ill-adult-patients\/","title":{"rendered":"Recommendations for lung ventilation and perfusion assessment with chest electrical impedance tomography in critically ill adult patients."},"content":{"rendered":"<h2 id=\"ember62\" class=\"ember-view reader-text-block__heading-2\">Global Consensus on Electrical Impedance Tomography in Critical Care<\/h2>\n<hr class=\"reader-divider-block__horizontal-rule\" \/>\n<h3 id=\"ember63\" class=\"ember-view reader-text-block__heading-3\">\ud83e\ude7a Abstract<\/h3>\n<p id=\"ember64\" class=\"ember-view reader-text-block__paragraph\">Electrical Impedance Tomography (EIT) is a <strong>non-invasive, radiation-free imaging technology<\/strong> that allows continuous bedside monitoring of lung ventilation and perfusion in critically ill patients. Despite its increasing use, <strong>standardized international guidelines<\/strong> have been lacking. This large-scale Delphi consensus study\u2014led by the REspiratory and Critical Care Medicine EIT (RECCE) group\u2014reviewed over <strong>11,000 studies<\/strong> and formulated <strong>87 recommendations<\/strong>, covering data acquisition, analysis, clinical application, and future directions. Consensus was achieved on 85 statements (15 with &gt;95% agreement), offering the <strong>first global evidence-based framework<\/strong> for EIT in adult critical care. These recommendations strengthen the role of EIT in <strong>PEEP titration, lung recruitability assessment, ECMO management, and detection of ventilation-perfusion mismatches<\/strong>, marking a milestone in the global standardization of bedside functional lung imaging.<\/p>\n<hr class=\"reader-divider-block__horizontal-rule\" \/>\n<h3 id=\"ember65\" class=\"ember-view reader-text-block__heading-3\">\ud83d\udd0d 10 Key Insights:<\/h3>\n<hr class=\"reader-divider-block__horizontal-rule\" \/>\n<p id=\"ember66\" class=\"ember-view reader-text-block__paragraph\"><strong>1\ufe0f\u20e3 EIT as a Bedside Functional Imaging Tool:<\/strong> EIT provides continuous, radiation-free assessment of <strong>regional ventilation and perfusion<\/strong>, enabling detection of dynamic pulmonary changes, V\/Q mismatch, and recruitment in real time. It bridges the gap between imaging and physiological monitoring in the ICU.<\/p>\n<p id=\"ember67\" class=\"ember-view reader-text-block__paragraph\"><strong>2\ufe0f\u20e3 Scope and Methodology of the Consensus:<\/strong> An international panel of intensivists, biomedical engineers, and physiologists reviewed 11,159 abstracts and 242 eligible publications (1990\u20132024). Using Oxford\u2019s Levels of Evidence and a two-round Delphi process, <strong>87 recommendations<\/strong> were finalized with robust global agreement across 12 countries.<\/p>\n<p id=\"ember68\" class=\"ember-view reader-text-block__paragraph\"><strong>3\ufe0f\u20e3 Core Recommendations on Data Acquisition:<\/strong><\/p>\n<ul>\n<li><strong>Electrode placement:<\/strong> Preferably at the <strong>4th\u20135th intercostal spaces<\/strong>, adjusted for diaphragm position.<\/li>\n<li><strong>Consistency:<\/strong> Identical EIT-belt positioning is essential for repeated measurements.<\/li>\n<li><strong>Obesity and contact impedance:<\/strong> While body habitus alters lung contour, it does not hinder EIT\u2019s ability to monitor ventilation dynamically.<\/li>\n<\/ul>\n<p id=\"ember70\" class=\"ember-view reader-text-block__paragraph\"><strong>4\ufe0f\u20e3 Standardization of Analysis and Key Metrics:<\/strong> Strong consensus supports standardized use of indices such as:<\/p>\n<ul>\n<li><strong>End-expiratory lung impedance (EELI)<\/strong> to reflect volume changes.<\/li>\n<li><strong>Tidal impedance variation (TIV)<\/strong> as a surrogate for tidal volume.<\/li>\n<li><strong>Center of Ventilation (CoV)<\/strong> and <strong>Global Inhomogeneity Index (GI)<\/strong> for spatial ventilation patterns. Calibration with known tidal volume is advised before comparing datasets.<\/li>\n<\/ul>\n<p id=\"ember72\" class=\"ember-view reader-text-block__paragraph\"><strong>5\ufe0f\u20e3 PEEP and Tidal Volume Optimization:<\/strong> EIT allows individualized <strong>PEEP titration using regional compliance<\/strong> (Costa method), identifying the crossover between overdistension and collapse. The technique enables real-time evaluation of recruitment maneuvers and quantifies hyper-distension, guiding <strong>lung-protective ventilation<\/strong> strategies.<\/p>\n<p id=\"ember73\" class=\"ember-view reader-text-block__paragraph\"><strong>6\ufe0f\u20e3 Perfusion and V\/Q Assessment:<\/strong> Contrast-enhanced EIT (hypertonic saline 5\u201310%) achieved consensus as the preferred method for <strong>regional perfusion mapping<\/strong>. Breath-holding for \u22658 seconds during acquisition optimizes signal quality. The technique can identify <strong>pulmonary embolism and regional perfusion defects<\/strong>\u2014a breakthrough for functional hemodynamic imaging.<\/p>\n<p id=\"ember74\" class=\"ember-view reader-text-block__paragraph\"><strong>7\ufe0f\u20e3 Clinical Applications:<\/strong> EIT is validated for:<\/p>\n<ul>\n<li><strong>ARDS and ALI:<\/strong> Detecting recruitment\/de-recruitment and guiding ventilation.<\/li>\n<li><strong>Prone positioning:<\/strong> Quantifying dorsal recruitment and improved V\/Q matching.<\/li>\n<li><strong>ECMO:<\/strong> Individualizing PEEP and tidal volume in both V-V and V-A ECMO settings.<\/li>\n<li><strong>Weaning trials:<\/strong> Monitoring regional ventilation shifts during spontaneous breathing.<\/li>\n<li><strong>Self-inflicted lung injury (P-SILI):<\/strong> Detecting pendelluft and patient effort heterogeneity.<\/li>\n<\/ul>\n<p id=\"ember76\" class=\"ember-view reader-text-block__paragraph\"><strong>8\ufe0f\u20e3 Comparison to 2017 TREND Consensus:<\/strong> Unlike TREND (focused on methodology), the <strong>RECCE 2025 consensus<\/strong> emphasizes clinical translation. It expands beyond ventilation to <strong>integrate perfusion<\/strong>, rehabilitation applications, and emerging technologies such as 3D EIT and multi-layer electrode systems.<\/p>\n<p id=\"ember77\" class=\"ember-view reader-text-block__paragraph\"><strong>9\ufe0f\u20e3 Evidence Limitations and Future Trials:<\/strong> Most statements are supported by <strong>moderate-level (B)<\/strong> or <strong>expert-based (D)<\/strong> evidence, with only 3 high-quality (A) recommendations. The authors call for <strong>multicenter RCTs<\/strong> to validate EIT-guided mechanical ventilation and perfusion imaging in ARDS and ECMO.<\/p>\n<p id=\"ember78\" class=\"ember-view reader-text-block__paragraph\"><strong>\ud83d\udd1f Training, Standardization, and Future Directions:<\/strong><\/p>\n<ul>\n<li>Mandatory EIT training for clinicians interpreting functional images.<\/li>\n<li>Development of <strong>automated analysis and 3D imaging<\/strong> to enhance reproducibility.<\/li>\n<li>Expansion of perfusion imaging protocols beyond saline bolus\u2014potentially toward <strong>non-invasive cardiac-cycle calibration<\/strong>.<\/li>\n<li>Establishment of <strong>EIT reference values<\/strong> across disease phenotypes.<\/li>\n<\/ul>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"aligncenter wp-image-1457 size-large\" src=\"https:\/\/perfusfind.com\/ic\/wp-content\/uploads\/2026\/03\/1761098620625-726x1024.jpg\" alt=\"\" width=\"726\" height=\"1024\" srcset=\"https:\/\/perfusfind.com\/ic\/wp-content\/uploads\/2026\/03\/1761098620625-726x1024.jpg 726w, https:\/\/perfusfind.com\/ic\/wp-content\/uploads\/2026\/03\/1761098620625-213x300.jpg 213w, https:\/\/perfusfind.com\/ic\/wp-content\/uploads\/2026\/03\/1761098620625-768x1083.jpg 768w, https:\/\/perfusfind.com\/ic\/wp-content\/uploads\/2026\/03\/1761098620625.jpg 1064w\" sizes=\"(max-width: 726px) 100vw, 726px\" \/><\/p>\n<h3 id=\"ember81\" class=\"ember-view reader-text-block__heading-3\">Clinical Takeaways<\/h3>\n<ul>\n<li><strong>EIT is no longer experimental<\/strong>\u2014it is now endorsed by an international expert panel for real-time bedside assessment.<\/li>\n<li>Enables <strong>personalized mechanical ventilation<\/strong>, V\/Q evaluation, and physiologic monitoring during ECMO.<\/li>\n<li>The technology\u2019s integration into clinical protocols could reshape <strong>ARDS management, lung-protective ventilation, and early diagnosis of complications<\/strong>.<\/li>\n<\/ul>\n<p><strong><a class=\"article-editor-link article-editor-link\" style=\"font-size: 16px; background-color: #ffffff;\" href=\"https:\/\/www.thelancet.com\/journals\/eclinm\/article\/PIIS2589-5370(25)00508-5\/fulltext\" rel=\"noopener noreferrer\">ACCESS FULL ARTICLE HERE<\/a><\/strong><\/p>\n<p><img decoding=\"async\" class=\"alignnone size-medium wp-image-1458\" src=\"https:\/\/perfusfind.com\/ic\/wp-content\/uploads\/2026\/03\/1761098686618-300x300.png\" alt=\"\" width=\"300\" height=\"300\" srcset=\"https:\/\/perfusfind.com\/ic\/wp-content\/uploads\/2026\/03\/1761098686618-300x300.png 300w, https:\/\/perfusfind.com\/ic\/wp-content\/uploads\/2026\/03\/1761098686618-150x150.png 150w, https:\/\/perfusfind.com\/ic\/wp-content\/uploads\/2026\/03\/1761098686618.png 450w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<h3 id=\"ember84\" class=\"ember-view reader-text-block__heading-3\">Discussion<\/h3>\n<p id=\"ember85\" class=\"ember-view reader-text-block__paragraph\">As EIT transitions from research to real-world use\u2014will it redefine how we titrate PEEP, detect V\/Q mismatch, and individualize ventilation?<\/p>\n<p>&nbsp;<\/p>\n<p id=\"ember87\" class=\"ember-view reader-text-block__paragraph\"><strong>Open Access<\/strong> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article&#8217;s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article&#8217;s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit <a class=\"QPSBGRTTCToxrpUoVsOUnfwcbljCvWXALY \" tabindex=\"0\" href=\"http:\/\/creativecommons.org\/licenses\/by\/4.0\/\" target=\"_self\" data-test-app-aware-link=\"\"><strong>http:\/\/creativecommons.org\/licenses\/by\/4.0\/<\/strong><\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Global Consensus on Electrical Impedance Tomography in Critical Care \ud83e\ude7a Abstract Electrical Impedance Tomography (EIT) is a non-invasive, radiation-free imaging technology that allows continuous bedside monitoring of lung ventilation and perfusion in critically ill patients. Despite its increasing use, standardized international guidelines have been lacking. This large-scale Delphi consensus study\u2014led by the REspiratory and Critical [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1459,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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