Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
UH/CVC Department of Respiratory Care, University of Michigan, Ann Arbor, MI.
Crit Care Med. 2022 Aug 1;50(8):1210-1223. doi: 10.1097/CCM.0000000000005582. Epub 2022 May 23.
To describe, through a narrative review, the physiologic principles underlying electrical impedance tomography, and its potential applications in managing acute respiratory distress syndrome (ARDS). To address the current evidence supporting its use in different clinical scenarios along the ARDS management continuum.
We performed an online search in Pubmed to review articles. We searched MEDLINE, Cochrane Central Register, and clinicaltrials.gov for controlled trials databases.
Selected publications included case series, pilot-physiologic studies, observational cohorts, and randomized controlled trials. To describe the rationale underlying physiologic principles, we included experimental studies.
Data from relevant publications were reviewed, analyzed, and its content summarized.
Electrical impedance tomography is an imaging technique that has aided in understanding the mechanisms underlying multiple interventions used in ARDS management. It has the potential to monitor and predict the response to prone positioning, aid in the dosage of flow rate in high-flow nasal cannula, and guide the titration of positive-end expiratory pressure during invasive mechanical ventilation. The latter has been demonstrated to improve physiologic and mechanical parameters correlating with lung recruitment. Similarly, its use in detecting pneumothorax and harmful patient-ventilator interactions such as pendelluft has been proven effective. Nonetheless, its impact on clinically meaningful outcomes remains to be determined.
Electrical impedance tomography is a potential tool for the individualized management of ARDS throughout its different stages. Clinical trials should aim to determine whether a specific approach can improve clinical outcomes in ARDS management.
通过叙述性综述描述电阻抗断层成像的生理原理及其在急性呼吸窘迫综合征（ARDS）管理中的潜在应用。探讨支持其在 ARDS 管理连续体不同临床情况下应用的当前证据。
我们在 Pubmed 上进行了在线搜索以查阅文章。我们在 MEDLINE、Cochrane 中心注册库和 clinicaltrials.gov 中搜索了对照试验数据库。
入选的出版物包括病例系列、初步生理研究、观察队列和随机对照试验。为了描述生理原理背后的基本原理，我们纳入了实验研究。
对相关出版物的数据进行了回顾、分析和内容总结。
电阻抗断层成像是一种成像技术，有助于了解 ARDS 管理中多种干预措施的作用机制。它具有监测和预测俯卧位的反应、辅助高流量鼻导管中流速的剂量、以及指导有创机械通气时呼气末正压的滴定的潜力。后者已被证明可以改善与肺复张相关的生理和机械参数。同样，其在检测气胸和有害的人机交互（如 pendelluft）方面的有效性也已得到证实。然而，其对临床有意义结局的影响仍有待确定。
电阻抗断层成像可能是 ARDS 不同阶段个体化管理的工具。临床试验应旨在确定特定方法是否可以改善 ARDS 管理中的临床结局。
