Franchineau Guillaume, Jonkman Annemijn H, Piquilloud Lise, Yoshida Takeshi, Costa Eduardo, Rozé Hadrien, Camporota Luigi, Piraino Thomas, Spinelli Elena, Combes Alain, Alcala Glasiele C, Amato Marcelo, Mauri Tommaso, Frerichs Inéz, Brochard Laurent J, Schmidt Matthieu
Service de Medecine Intensive Reanimation, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France.
Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Respir Crit Care Med. 2024 Mar 15;209(6):670-682. doi: 10.1164/rccm.202306-1118CI.
Hypoxemic respiratory failure is one of the leading causes of mortality in intensive care. Frequent assessment of individual physiological characteristics and delivery of personalized mechanical ventilation (MV) settings is a constant challenge for clinicians caring for these patients. Electrical impedance tomography (EIT) is a radiation-free bedside monitoring device that is able to assess regional lung ventilation and changes in aeration. With real-time tomographic functional images of the lungs obtained through a thoracic belt, clinicians can visualize and estimate the distribution of ventilation at different ventilation settings or following procedures such as prone positioning. Several studies have evaluated the performance of EIT to monitor the effects of different MV settings in patients with acute respiratory distress syndrome, allowing more personalized MV. For instance, EIT could help clinicians find the positive end-expiratory pressure that represents a compromise between recruitment and overdistension and assess the effect of prone positioning on ventilation distribution. The clinical impact of the personalization of MV remains to be explored. Despite inherent limitations such as limited spatial resolution, EIT also offers a unique noninvasive bedside assessment of regional ventilation changes in the ICU. This technology offers the possibility of a continuous, operator-free diagnosis and real-time detection of common problems during MV. This review provides an overview of the functioning of EIT, its main indices, and its performance in monitoring patients with acute respiratory failure. Future perspectives for use in intensive care are also addressed.
低氧血症性呼吸衰竭是重症监护中主要的死亡原因之一。对个体生理特征进行频繁评估并提供个性化机械通气（MV）设置，对于护理这些患者的临床医生来说始终是一项挑战。电阻抗断层成像（EIT）是一种无辐射的床边监测设备，能够评估局部肺通气及通气变化情况。通过胸带获取肺部实时断层功能图像，临床医生可以直观看到并估计在不同通气设置下或在诸如俯卧位等操作后的通气分布情况。多项研究评估了EIT监测急性呼吸窘迫综合征患者不同MV设置效果的性能，从而实现更个性化的MV。例如，EIT可以帮助临床医生找到代表肺复张和过度扩张之间平衡的呼气末正压，并评估俯卧位对通气分布的影响。MV个性化的临床影响仍有待探索。尽管存在诸如空间分辨率有限等固有局限性，但EIT也为重症监护病房区域通气变化提供了独特的无创床边评估。这项技术提供了在MV期间进行连续、无需操作人员的诊断以及实时检测常见问题的可能性。本综述概述了EIT的工作原理、其主要指标以及在监测急性呼吸衰竭患者中的性能。还讨论了其在重症监护中的未来应用前景。
