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Cui Z, Liu X, Qu H, Wang H. Technical Principles and Clinical Applications of Electrical Impedance Tomography in Pulmonary Monitoring. SENSORS (BASEL, SWITZERLAND) 2024; 24:4539. [PMID: 39065936 PMCID: PMC11281055 DOI: 10.3390/s24144539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/11/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
Pulmonary monitoring is crucial for the diagnosis and management of respiratory conditions, especially after the epidemic of coronavirus disease. Electrical impedance tomography (EIT) is an alternative non-radioactive tomographic imaging tool for monitoring pulmonary conditions. This review proffers the current EIT technical principles and applications on pulmonary monitoring, which gives a comprehensive summary of EIT applied on the chest and encourages its extensive usage to clinical physicians. The technical principles involving EIT instrumentations and image reconstruction algorithms are explained in detail, and the conditional selection is recommended based on clinical application scenarios. For applications, specifically, the monitoring of ventilation/perfusion (V/Q) is one of the most developed EIT applications. The matching correlation of V/Q could indicate many pulmonary diseases, e.g., the acute respiratory distress syndrome, pneumothorax, pulmonary embolism, and pulmonary edema. Several recently emerging applications like lung transplantation are also briefly introduced as supplementary applications that have potential and are about to be developed in the future. In addition, the limitations, disadvantages, and developing trends of EIT are discussed, indicating that EIT will still be in a long-term development stage before large-scale clinical applications.
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Affiliation(s)
- Ziqiang Cui
- School of Electrical and Information Engineering, Tianjin University, Tianjin 300072, China; (X.L.); (H.Q.); (H.W.)
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Rahtu M, Frerichs I, Pokka T, Becher T, Peltoniemi O, Kallio M. Effect of body position on ventilation distribution in healthy newborn infants: an observational study. Arch Dis Child Fetal Neonatal Ed 2024; 109:322-327. [PMID: 38071525 DOI: 10.1136/archdischild-2023-325967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/15/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Newborn infants have unique respiratory physiology compared with older children and adults due to their lungs' structural and functional immaturity and highly compliant chest wall. To date, ventilation distribution has seldom been studied in this age group. This study aims to assess the effect of body position on ventilation distribution in spontaneously breathing healthy neonates. DESIGN Prospective observational study. SETTING Maternity wards of Oulu University Hospital. PATIENTS 20 healthy, spontaneously breathing, newborn infants. INTERVENTIONS Electrical impedance tomography data were recorded with a 32-electrode belt (Sentec AG, Landquart, Switzerland) in six different body positions in random order. Ventilation distribution was retrospectively assessed 10 minutes after each position change. MAIN OUTCOME MEASURES In each position, regional tidal impedance variation (ΔZ) and ventral-to-dorsal and right-to-left centre of ventilation were measured. RESULTS The mean global ΔZ was the largest in supine position and it was smaller in prone and lateral positions. Yet, global ΔZ did not differ in supine positions, ventilation distribution was more directed towards the non-dependent lung region in supine tilted position (p<0.001). In prone, a reduction of global ΔZ was observed (p<0.05) corresponding to an amount of 10% of global tidal variation in supine position. In both lateral positions, tidal ventilation was distributed more to the corresponding non-dependent lung region. CONCLUSIONS Prone or lateral body positioning in healthy spontaneously breathing newborns leads to a redistribution of ventilation to the non-dependent lung regions and at the same time global tidal volume is reduced as compared with supine.
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Affiliation(s)
- Marika Rahtu
- Department of Pediatrics and Adolescent Medicine and Research Unit of Clinical Medicine, Oulu University Hospital, Oulu, Finland
| | - Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Tytti Pokka
- Department of Pediatrics and Adolescent Medicine and Research Unit of Clinical Medicine, Oulu University Hospital, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Tobias Becher
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Outi Peltoniemi
- Department of Pediatrics and Adolescent Medicine and Research Unit of Clinical Medicine, Oulu University Hospital, Oulu, Finland
| | - Merja Kallio
- Department of Pediatrics and Adolescent Medicine and Research Unit of Clinical Medicine, Oulu University Hospital, Oulu, Finland
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Yaremenko AV, Pechnikova NA, Porpodis K, Damdoumis S, Aggeli A, Theodora P, Domvri K. Association of Fetal Lung Development Disorders with Adult Diseases: A Comprehensive Review. J Pers Med 2024; 14:368. [PMID: 38672994 PMCID: PMC11051200 DOI: 10.3390/jpm14040368] [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: 02/22/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Fetal lung development is a crucial and complex process that lays the groundwork for postnatal respiratory health. However, disruptions in this delicate developmental journey can lead to fetal lung development disorders, impacting neonatal outcomes and potentially influencing health outcomes well into adulthood. Recent research has shed light on the intriguing association between fetal lung development disorders and the development of adult diseases. Understanding these links can provide valuable insights into the developmental origins of health and disease, paving the way for targeted preventive measures and clinical interventions. This review article aims to comprehensively explore the association of fetal lung development disorders with adult diseases. We delve into the stages of fetal lung development, examining key factors influencing fetal lung maturation. Subsequently, we investigate specific fetal lung development disorders, such as respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), congenital diaphragmatic hernia (CDH), and other abnormalities. Furthermore, we explore the potential mechanisms underlying these associations, considering the role of epigenetic modifications, transgenerational effects, and intrauterine environmental factors. Additionally, we examine the epidemiological evidence and clinical findings linking fetal lung development disorders to adult respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), and other respiratory ailments. This review provides valuable insights for healthcare professionals and researchers, guiding future investigations and shaping strategies for preventive interventions and long-term care.
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Affiliation(s)
- Alexey V. Yaremenko
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Oncology Unit, Pulmonary Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.P.); (S.D.)
| | - Nadezhda A. Pechnikova
- Laboratory of Chemical Engineering A’, School of Chemical Engineering, Faculty of Engineering, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (N.A.P.); (A.A.)
- Saint Petersburg Pasteur Institute, Saint Petersburg 197101, Russia
| | - Konstantinos Porpodis
- Oncology Unit, Pulmonary Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.P.); (S.D.)
| | - Savvas Damdoumis
- Oncology Unit, Pulmonary Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.P.); (S.D.)
| | - Amalia Aggeli
- Laboratory of Chemical Engineering A’, School of Chemical Engineering, Faculty of Engineering, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (N.A.P.); (A.A.)
| | - Papamitsou Theodora
- Laboratory of Histology-Embryology, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Kalliopi Domvri
- Oncology Unit, Pulmonary Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.P.); (S.D.)
- Laboratory of Histology-Embryology, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- Pathology Department, George Papanikolaou Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Frerichs I, Schädler D, Becher T. Setting positive end-expiratory pressure by using electrical impedance tomography. Curr Opin Crit Care 2024; 30:43-52. [PMID: 38085866 DOI: 10.1097/mcc.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
PURPOSE OF REVIEW This review presents the principles and possibilities of setting positive end-expiratory pressure (PEEP) using electrical impedance tomography (EIT). It summarizes the major findings of recent studies where EIT was applied to monitor the effects of PEEP on regional lung function and to guide the selection of individualized PEEP setting. RECENT FINDINGS The most frequent approach of utilizing EIT for the assessment of PEEP effects and the PEEP setting during the time period from January 2022 till June 2023 was based on the analysis of pixel tidal impedance variation, typically acquired during stepwise incremental and/or decremental PEEP variation. The most common EIT parameters were the fraction of ventilation in various regions of interest, global inhomogeneity index, center of ventilation, silent spaces, and regional compliance of the respiratory system. The studies focused mainly on the spatial and less on the temporal distribution of ventilation. Contrast-enhanced EIT was applied in a few studies for the estimation of ventilation/perfusion matching. SUMMARY The availability of commercial EIT devices resulted in an increase in clinical studies using this bedside imaging technology in neonatal, pediatric and adult critically ill patients. The clinical interest in EIT became evident but the potential of this method in clinical decision-making still needs to be fully exploited.
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Affiliation(s)
- Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Xiao Z, Yang L, Dai M, Lu W, Liu F, Frerichs I, Gao C, Sun X, Zhao Z. Regional ventilation distribution before and after laparoscopic lung parenchymal resection. Physiol Meas 2024; 45:015004. [PMID: 38176102 DOI: 10.1088/1361-6579/ad1b3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/04/2024] [Indexed: 01/06/2024]
Abstract
Objective.The aim of the present study was to evaluate the influence of one-sided pulmonary nodule and tumour on ventilation distribution pre- and post- partial lung resection.Approach.A total of 40 consecutive patients scheduled for laparoscopic lung parenchymal resection were included. Ventilation distribution was measured with electrical impedance tomography (EIT) in supine and surgery lateral positions 72 h before surgery (T1) and 48 h after extubation (T2). Left lung to global ventilation ratio (Fl), the global inhomogeneity index (GI), standard deviation of regional ventilation delay (RVDSD) and pendelluft amplitude (Apendelluft) were calculated to assess the spatial and temporal ventilation distribution.Main results.After surgery (T2), ventilation at the operated chest sides generally deteriorated compared to T1 as expected. For right-side resection, the differences were significant at both supine and left lateral positions (p< 0.001). The change of RVDSDwas in general more heterogeneous. For left-side resection, RVDSDwas worse at T2 compared to T1 at left lateral position (p= 0.002). The other EIT-based parameters showed no significant differences between the two time points. No significant differences were observed between supine and lateral positions for the same time points respectively.Significance.In the present study, we found that the surgery side influenced the ventilation distribution. When the resection was performed on the right lung, the postoperative ipsilateral ventilation was reduced and the right lung ratio fell significantly. When the resection was on the left lung, the ventilation delay was significantly increased.
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Affiliation(s)
- Zhibin Xiao
- Department of Anesthesiology, the 986th Air Force Hospital, Xijing hospital, the Air Force Medical University, Xi'an, Shaanxi 710032, People's Republic of China
| | - Lin Yang
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, People's Republic of China
| | - Meng Dai
- Department of Biomedical Engineering, Air Force Medical University, Xi'an, People's Republic of China
| | - Wenjun Lu
- Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi 710032, People's Republic of China
| | - Feng Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi 710032, People's Republic of China
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre of Schleswig-Holstein Campus Kiel, Germany
| | - Changjun Gao
- Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi 710032, People's Republic of China
| | - Xude Sun
- Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi 710032, People's Republic of China
| | - Zhanqi Zhao
- School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, People's Republic of China
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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Händel C, Becher T, Miedema M, Kallio M, Papadouri T, Waldmann AD, Sophocleous L, Karaoli C, Yerworth R, Bayford R, Rimensberger PC, van Kaam AH, Frerichs I. Effect of routine suction on lung aeration in critically ill neonates and young infants measured with electrical impedance tomography. Sci Rep 2023; 13:20842. [PMID: 38012186 PMCID: PMC10682352 DOI: 10.1038/s41598-023-42965-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/17/2023] [Indexed: 11/29/2023] Open
Abstract
Endotracheal suctioning is a widely used procedure to remove secretions from the airways of ventilated patients. Despite its prevalence, regional effects of this maneuver have seldom been studied. In this study, we explore its effects on regional lung aeration in neonates and young infants using electrical impedance tomography (EIT) as part of the large EU-funded multicenter observational study CRADL. 200 neonates and young infants in intensive care units were monitored with EIT for up to 72 h. EIT parameters were calculated to detect changes in ventilation distribution, ventilation inhomogeneity and ventilation quantity on a breath-by-breath level 5-10 min before and after suctioning. The intratidal change in aeration over time was investigated by means of regional expiratory time constants calculated from all respiratory cycles using an innovative procedure and visualized by 2D maps of the thoracic cross-section. 344 tracheal suctioning events from 51 patients could be analyzed. They showed no or very small changes of EIT parameters, with a dorsal shift of the center of ventilation by 0.5% of the chest diameter and a 7% decrease of tidal impedance variation after suctioning. Regional time constants did not change significantly. Routine suctioning led to EIT-detectable but merely small changes of the ventilation distribution in this study population. While still a measure requiring further study, the time constant maps may help clinicians interpret ventilation mechanics in specific cases.
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Affiliation(s)
- Claas Händel
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schlewig-Holstein, Campus Kiel, Kiel, Germany.
| | - Tobias Becher
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schlewig-Holstein, Campus Kiel, Kiel, Germany
| | - Martijn Miedema
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Merja Kallio
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, and Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Thalia Papadouri
- Neonatal Intensive Care Unit, Arch. Makarios III Hospital, Nicosia, Cyprus
| | - Andreas D Waldmann
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany
| | - Louiza Sophocleous
- Department of Electrical and Computer Engineering, KIOS Research Center, University of Cyprus, Nicosia, Cyprus
| | - Christina Karaoli
- Neonatal Intensive Care Unit, Arch. Makarios III Hospital, Nicosia, Cyprus
| | - Rebecca Yerworth
- Medical Physics and Biomedical Engineering Department, University College London, London, UK
| | - Richard Bayford
- Department of Natural Sciences, Middlesex University, London, UK
| | - Peter C Rimensberger
- Division of Neonatology and Pediatric Intensive Care, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schlewig-Holstein, Campus Kiel, Kiel, Germany
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Ribeiro De Santis Santiago R, Xin Y, Gaulton TG, Alcala G, León Bueno de Camargo ED, Cereda M, Britto Passos Amato M, Berra L. Lung Imaging Acquisition with Electrical Impedance Tomography: Tackling Common Pitfalls. Anesthesiology 2023; 139:329-341. [PMID: 37402247 DOI: 10.1097/aln.0000000000004613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Electrical impedance tomography is a powerful tool for lung imaging that can be employed at the bedside in multiple clinical scenarios. Diagnosing and preventing interpretation pitfalls will ensure reliable data and allow for appropriate clinical decision-making.
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Affiliation(s)
- Roberta Ribeiro De Santis Santiago
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yi Xin
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy G Gaulton
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Glasiele Alcala
- Pulmonary Division, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Erick Dario León Bueno de Camargo
- Federal University of ABC/Engineering, Modeling and Applied Social Sciences Centre, Biomedical Engineering, São Bernardo do Campo, Brazil
| | - Maurizio Cereda
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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