An Introduction to the Clinical Application and Interpretation of Electrical Impedance Tomography

Electrical impedance tomography: Usefulness for respiratory physiotherapy in critical illnesses

Respiratory physiotherapy, including the management of invasive mechanical ventilation (MV) and noninvasive mechanical ventilation (NIV), is a key supportive intervention for critically ill patients. MV has potential for inducing ventilator-induced lung injury (VILI) as well as long-term complications related to prolonged bed rest, such as post-intensive care syndrome and intensive care unit acquired weakness. Physical and respiratory therapy, developed by the critical care team, in a timely manner, has been shown to prevent these complications. In this pathway, real-time bedside monitoring of changes in pulmonary aeration and alveolar gas distribution associated with postural positioning, respiratory physiotherapy techniques and changes in MV strategies can be crucial in guiding these procedures, providing safe therapy and prevention of potential harm to the patient. Along this path, electrical impedance tomography (EIT) has emerged as a new key non-invasive bedside strategy free of radiation, to allow visualization of lung recruitment. This review article presents the main and potential applications of EIT in relation to physiotherapy techniques in the ICU setting.

Setting positive end-expiratory pressure by using electrical impedance tomography

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.

Lung Imaging Acquisition with Electrical Impedance Tomography: Tackling Common Pitfalls

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.

Flexible Electrodes as a Measuring System of Electrical Impedance Imaging

Electrical Impedance Tomography (EIT) is a detection imaging technology developed 30 years ago. When the conventional EIT measurement system is used, the electrode and the excitation measurement terminal are connected with a long wire, which is easily affected by external interference, and the measurement result is unstable. In this paper, we developed a flexible electrode device based on flexible electronics technology, which can be softly attached to the skin surface for real-time physiological monitoring. The flexible equipment includes an excitation measuring circuit and electrode, which eliminates the adverse effects of connecting long wires and improves the effectiveness of measuring signals. At the same time, the design also uses flexible electronic technology to make the system structure achieve ultra-low modulus and high tensile strength so that the electronic equipment has soft mechanical properties. Experiments have shown that when the flexible electrode is deformed, its function is completely unaffected, the measurement results remain stable, and the static and fatigue performances are satisfactory. The flexible electrode has high system accuracy and good anti-interference.