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Yu M, Deng Y, Cha J, Jiang L, Wang M, Qiao S, Wang C. PEEP titration by EIT strategies for patients with ARDS: A systematic review and meta-analysis. Med Intensiva 2022:S2173-5727(22)00207-7. [PMID: 36243630 DOI: 10.1016/j.medine.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/04/2022] [Accepted: 06/20/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To determine which method of Positive End-expiratory Pressure (PEEP) titration is more useful, and to establish an evidence base for the clinical impact of Electrical Impedance Tomography (EIT) based individual PEEP setting which appears to be a promising method to optimize PEEP in Acute Respiratory Distress Syndrome (ARDS) patients. DESIGN A systematic review and meta-analysis. SETTING 4 databases (PUBMED, EMBASE, Web Of Science, and the Cochrane Library) from 1980 to December 2020 were performed. PARTICIPANTS Randomized clinical trials patients with ARDS. MAIN VARIABLES PaO2/FiO2-ratio and respiratory system compliance. INTERVENSION The quality of the studies was assessed with the Cochrane risk and bias tool. RESULTS 8 trials, including a total of 222 participants, were eligible for analysis. Meta-analysis demonstrates a significantly EIT-based individual PEEP setting for patients receiving higher PaO2/FiO2 ratio as compared to other PEEP titration strategies [5 trials, 202 patients, SMD 0.636, (95% CI 0.364-0.908)]. EIT-drived PEEP titration strategy did not significantly increase respiratory system compliance when compared to other peep titration strategies, [7 trials, 202 patients, SMD -0.085, (95% CI -0.342 to 0.172)]. CONCLUSIONS The benefits of PEEP titration with EIT on clinical outcomes of ARDS in placebo-controlled trials probably result from the visible regional ventilation of EIT. These findings offer clinicians and stakeholders a comprehensive assessment and high-quality evidence for the safety and efficacy of the EIT-based individual PEEP setting as a superior option for patients who undergo ARDS.
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Affiliation(s)
- Mengnan Yu
- Faculty of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou, Jiangsu Province, China
| | - Yanjun Deng
- Faculty of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou, Jiangsu Province, China; Department of Intensive Care Unit, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou, Jiangsu Province, China
| | - Jun Cha
- Faculty of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou, Jiangsu Province, China
| | - Lingyan Jiang
- Faculty of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou, Jiangsu Province, China
| | - Mingdeng Wang
- Faculty of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou, Jiangsu Province, China; Department of Intensive Care Unit, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou, Jiangsu Province, China
| | - Shigang Qiao
- Faculty of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou, Jiangsu Province, China; Institute of Clinical Medicine Research, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou, Jiangsu Province, China
| | - Chen Wang
- Faculty of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou, Jiangsu Province, China; Institute of Clinical Medicine Research, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou, Jiangsu Province, China.
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González-Suárez A, Pérez JJ, Irastorza RM, D'Avila A, Berjano E. Computer modeling of radiofrequency cardiac ablation: 30 years of bioengineering research. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 214:106546. [PMID: 34844766 DOI: 10.1016/j.cmpb.2021.106546] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
This review begins with a rationale of the importance of theoretical, mathematical and computational models for radiofrequency (RF) catheter ablation (RFCA). We then describe the historical context in which each model was developed, its contribution to the knowledge of the physics of RFCA and its implications for clinical practice. Next, we review the computer modeling studies intended to improve our knowledge of the biophysics of RFCA and those intended to explore new technologies. We describe the most important technical details of the implementation of mathematical models, including governing equations, tissue properties, boundary conditions, etc. We discuss the utility of lumped element models, which despite their simplicity are widely used by clinical researchers to provide a physical explanation of how RF power is absorbed in different tissues. Computer model verification and validation are also discussed in the context of RFCA. The article ends with a section on the current limitations, i.e. aspects not yet included in state-of-the-art RFCA computer modeling and on future work aimed at covering the current gaps.
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Affiliation(s)
- Ana González-Suárez
- Electrical and Electronic Engineering, National University of Ireland Galway, Ireland; Translational Medical Device Lab, National University of Ireland Galway, Ireland
| | - Juan J Pérez
- Department of Electronic Engineering, BioMIT, Universitat Politècnica de València, Valencia, Spain
| | - Ramiro M Irastorza
- Instituto de Física de Líquidos y Sistemas Biológicos (CONICET), La Plata, Argentina; Instituto de Ingeniería y Agronomía, Universidad Nacional Arturo Jauretche, Florencio Varela, Argentina
| | - Andre D'Avila
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Enrique Berjano
- Department of Electronic Engineering, BioMIT, Universitat Politècnica de València, Valencia, Spain.
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4
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Chang CC, Huang ZY, Shih SF, Luo Y, Ko A, Cui Q, Sumner J, Cavallero S, Das S, Gao W, Sinsheimer J, Bui A, Jacobs JP, Pajukanta P, Wu H, Tai YC, Li Z, Hsiai TK. Electrical impedance tomography for non-invasive identification of fatty liver infiltrate in overweight individuals. Sci Rep 2021; 11:19859. [PMID: 34615918 PMCID: PMC8494919 DOI: 10.1038/s41598-021-99132-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/16/2021] [Indexed: 01/23/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of cardiometabolic diseases in overweight individuals. While liver biopsy is the current gold standard to diagnose NAFLD and magnetic resonance imaging (MRI) is a non-invasive alternative still under clinical trials, the former is invasive and the latter costly. We demonstrate electrical impedance tomography (EIT) as a portable method for detecting fatty infiltrate. We enrolled 19 overweight subjects to undergo liver MRI scans, followed by EIT measurements. The MRI images provided the a priori knowledge of the liver boundary conditions for EIT reconstruction, and the multi-echo MRI data quantified liver proton-density fat fraction (PDFF%) to validate fat infiltrate. Using the EIT electrode belts, we circumferentially injected pairwise current to the upper abdomen, followed by acquiring the resulting surface-voltage to reconstruct the liver conductivity. Pearson's correlation analyses compared EIT conductivity or MRI PDFF with body mass index, age, waist circumference, height, and weight variables. We reveal that the correlation between liver EIT conductivity or MRI PDFF with demographics is statistically insignificant, whereas liver EIT conductivity is inversely correlated with MRI PDFF (R = -0.69, p = 0.003, n = 16). As a pilot study, EIT conductivity provides a portable method for operator-independent and cost-effective detection of hepatic steatosis.
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Affiliation(s)
- Chih-Chiang Chang
- Department of Bioengineering, UCLA, Los Angeles, CA, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Zi-Yu Huang
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Shu-Fu Shih
- Department of Bioengineering, UCLA, Los Angeles, CA, USA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yuan Luo
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Arthur Ko
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Qingyu Cui
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer Sumner
- Department of Psychology, College of Life Sciences, UCLA, Los Angeles, CA, USA
| | - Susana Cavallero
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Swarna Das
- Department of Bioengineering, UCLA, Los Angeles, CA, USA
| | - Wei Gao
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Janet Sinsheimer
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA.,Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Computational Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alex Bui
- Department of Bioengineering, UCLA, Los Angeles, CA, USA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan P Jacobs
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
| | - Päivi Pajukanta
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Institute for Precision Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Holden Wu
- Department of Bioengineering, UCLA, Los Angeles, CA, USA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yu-Chong Tai
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Zhaoping Li
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA.,Center for Human Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tzung K Hsiai
- Department of Bioengineering, UCLA, Los Angeles, CA, USA. .,Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA. .,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA.
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5
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Shi Y, Tian Z, Wang M, Fu F, Wu Y. Arrangement of boundary electrodes for detection of frontal lobe disease with electrical impedance tomography. J Med Imaging (Bellingham) 2021; 8:044501. [PMID: 34250199 DOI: 10.1117/1.jmi.8.4.044501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: Caused by brain trauma or blood vessel abnormality, intracerebral hemorrhage and secondary ischemia have become prevalent and severe neurological diseases. The timely and accurate detection of disease is essential for the recovery of patients. As an emerging visualization technique, electrical impedance tomography (EIT) offers an alternative. It is able to reconstruct the conductivity distribution that reflects the pathological variation of human tissue. Approach: In the EIT-based detection, electrodes are usually in uniform arrangement, which may be not suitable in some conditions. To enhance sensitivity in the region of interest, EIT with a novel offset arrangement of boundary electrodes is proposed to image a simulated frontal lobe hemorrhage and secondary ischemia. To cope with the ill-posed inverse problem, the L1 regularization method is developed during the reconstruction. In addition, the impact of noise with a signal-to-noise ratio of 56 dB is studied. Results: Compared with the traditional uniform electrode arrangement, the results demonstrate that EIT with the proposed offset arrangement of electrodes is more advantageous for imaging frontal lobe disease. Conclusions: The proposed offset arrangement of electrodes is superior to the traditional uniform arrangement in imaging frontal lobe disease, especially under the impact of noise.
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Affiliation(s)
- Yanyan Shi
- Henan Normal University, College of Electronic and Electrical Engineering, Xinxiang, China.,Fourth Military Medical University, School of Biomedical Engineering, Xi'an, China
| | - Zhiwei Tian
- Henan Normal University, College of Electronic and Electrical Engineering, Xinxiang, China
| | - Meng Wang
- Henan Normal University, College of Electronic and Electrical Engineering, Xinxiang, China
| | - Feng Fu
- Fourth Military Medical University, School of Biomedical Engineering, Xi'an, China
| | - Yuehui Wu
- Henan Normal University, College of Electronic and Electrical Engineering, Xinxiang, China
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Poni R, Neufeld E, Capstick M, Bodis S, Samaras T, Kuster N. Feasibility of Temperature Control by Electrical Impedance Tomography in Hyperthermia. Cancers (Basel) 2021; 13:3297. [PMID: 34209300 PMCID: PMC8268554 DOI: 10.3390/cancers13133297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022] Open
Abstract
We present a simulation study investigating the feasibility of electrical impedance tomography (EIT) as a low cost, noninvasive technique for hyperthermia (HT) treatment monitoring and adaptation. Temperature rise in tissues leads to perfusion and tissue conductivity changes that can be reconstructed in 3D by EIT to noninvasively map temperature and perfusion. In this study, we developed reconstruction methods and investigated the achievable accuracy of EIT by simulating HT treatmentlike scenarios, using detailed anatomical models with heterogeneous conductivity distributions. The impact of the size and location of the heated region, the voltage measurement signal-to-noise ratio, and the reference model personalization and accuracy were studied. Results showed that by introducing an iterative reconstruction approach, combined with adaptive prior regions and tissue-dependent penalties, planning-based reference models, measurement-based reweighting, and physics-based constraints, it is possible to map conductivity-changes throughout the heated domain, with an accuracy of around 5% and cm-scale spatial resolution. An initial exploration of the use of multifrequency EIT to separate temperature and perfusion effects yielded promising results, indicating that temperature reconstruction accuracy can be in the order of 1 ∘C. Our results suggest that EIT can provide valuable real-time HT monitoring capabilities. Experimental confirmation in real-world conditions is the next step.
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Affiliation(s)
- Redi Poni
- Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETH), 8092 Zurich, Switzerland; (R.P.); (N.K.)
- Foundation for Research on Information Technologies in Society (IT’IS), 8004 Zurich, Switzerland; (M.C.); (S.B.)
| | - Esra Neufeld
- Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETH), 8092 Zurich, Switzerland; (R.P.); (N.K.)
- Foundation for Research on Information Technologies in Society (IT’IS), 8004 Zurich, Switzerland; (M.C.); (S.B.)
| | - Myles Capstick
- Foundation for Research on Information Technologies in Society (IT’IS), 8004 Zurich, Switzerland; (M.C.); (S.B.)
| | - Stephan Bodis
- Foundation for Research on Information Technologies in Society (IT’IS), 8004 Zurich, Switzerland; (M.C.); (S.B.)
- Center of Radiation Oncology KSA-KSB, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Theodoros Samaras
- Department of Physics, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Niels Kuster
- Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETH), 8092 Zurich, Switzerland; (R.P.); (N.K.)
- Foundation for Research on Information Technologies in Society (IT’IS), 8004 Zurich, Switzerland; (M.C.); (S.B.)
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