SESSION TITLE: Procedures in the Lung: From Airways to VesselsSESSION TYPE: Original InvestigationsPRESENTED ON: 10/17/2022 1:30 pm - 2:30 pmPURPOSE: Bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBV) is performed in selected patients with severe emphysema; however, intraprocedural techniques evaluating efficacy of lobar occlusion are limited, especially when available measures of collateral ventilation are inadequate. Electrical impedance tomography (EIT) is a bedside-available, radiation-free imaging modality that can demonstrate regional ventilatory changes in real time. We describe our initial experience with performing EIT during BLVR as part of an ongoing safety and feasibility study utilizing intraprocedural EIT.METHODS: After IRB approval (#2021P000782) and written informed consent, patients undergoing BLVR at Beth Israel Deaconess Medical Center were prospectively enrolled in this study. EIT belts were placed in the pre-operative care unit and remained in place for the entire procedural duration; EIT measurements of 60 seconds (Enlight 1800, Timpel Medical, Sao Paulo, Brazil) were performed before induction, after endotracheal intubation, during ChartisÔ evaluation, after EBV placement and after extubation. Herein we report feasibility and analyzed the center of ventilation in the lateral direction relative to the treated lung, immediately before and after valve placement.RESULTS: Our initial experience with 6 patients is described. All patients approached for consent participated in the study. There were no reported side effects from EIT. Measurements were successfully performed in 5 of 6 patients. Four of five patients (80%) with EIT measurements pre- and post-EBV placement demonstrated an intraprocedural shift in ventilation towards the nontreated lung, with a mean decrease in treated lung ventilation of 8.8% (standard deviation [SD] 5.9%); three demonstrated shifts > 10%. The mean change in center-of-ventilation, as measured by a 32x32 pixel matrix, was 1.18 (SD 0.51) pixels. Notably, in 2 patients, changes in regional ventilation by EIT were seen after valve placement despite equivocal measurements of collateral ventilation via ChartisÔ (immediate low flow/no flow profile). Two of 6 patients developed evidence of lobar atelectasis within 72 hours of valve placement; intraprocedural EIT images and post-procedural chest X-rays in one such patient are demonstrated.CONCLUSIONS: Electrical impedance tomography may provide real-time evidence of intraprocedural changes in regional ventilation during interventional pulmonary procedures, including EBV placement. Further research is necessary to correlate intraprocedural EIT with important clinical outcomes such as target lobe volume reduction, spirometry changes and symptoms after BLVR.CLINICAL IMPLICATIONS: EIT is safe and feasible during BLVR, and may provide intraprocedural evidence of successful lobar occlusion.DISCLOSURES: No relevant relationships by Basit AziziNo relevant relationships by Elias Baedorf KassisConsultant relationship with Boston Scientific Please note: $1001 - $5000 by Adnan Majid, value=Consulting feeConsultant relationship with olympus Please note: $5001 - $20000 by Adnan Majid, value=Consulting feeConsultant relationship with pinacle biologics Please note: $1001 - $5000 by Adnan Majid, value=Consulting feeNo relevant relationships by Ricardo MunozNo relevant relationships by Mihir ParikhNo relevant relationships by Maximilian SchaeferNo relevant relationships by Aiman SuleimanNo relevant relationships by Kai Swenson SESSION TITLE: Procedures in the Lung: From Airways to Vessels SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 1:30 pm - 2:30 pm PURPOSE: Bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBV) is performed in selected patients with severe emphysema; however, intraprocedural techniques evaluating efficacy of lobar occlusion are limited, especially when available measures of collateral ventilation are inadequate. Electrical impedance tomography (EIT) is a bedside-available, radiation-free imaging modality that can demonstrate regional ventilatory changes in real time. We describe our initial experience with performing EIT during BLVR as part of an ongoing safety and feasibility study utilizing intraprocedural EIT. METHODS: After IRB approval (#2021P000782) and written informed consent, patients undergoing BLVR at Beth Israel Deaconess Medical Center were prospectively enrolled in this study. EIT belts were placed in the pre-operative care unit and remained in place for the entire procedural duration; EIT measurements of 60 seconds (Enlight 1800, Timpel Medical, Sao Paulo, Brazil) were performed before induction, after endotracheal intubation, during ChartisÔ evaluation, after EBV placement and after extubation. Herein we report feasibility and analyzed the center of ventilation in the lateral direction relative to the treated lung, immediately before and after valve placement. RESULTS: Our initial experience with 6 patients is described. All patients approached for consent participated in the study. There were no reported side effects from EIT. Measurements were successfully performed in 5 of 6 patients. Four of five patients (80%) with EIT measurements pre- and post-EBV placement demonstrated an intraprocedural shift in ventilation towards the nontreated lung, with a mean decrease in treated lung ventilation of 8.8% (standard deviation [SD] 5.9%); three demonstrated shifts > 10%. The mean change in center-of-ventilation, as measured by a 32x32 pixel matrix, was 1.18 (SD 0.51) pixels. Notably, in 2 patients, changes in regional ventilation by EIT were seen after valve placement despite equivocal measurements of collateral ventilation via ChartisÔ (immediate low flow/no flow profile). Two of 6 patients developed evidence of lobar atelectasis within 72 hours of valve placement; intraprocedural EIT images and post-procedural chest X-rays in one such patient are demonstrated. CONCLUSIONS: Electrical impedance tomography may provide real-time evidence of intraprocedural changes in regional ventilation during interventional pulmonary procedures, including EBV placement. Further research is necessary to correlate intraprocedural EIT with important clinical outcomes such as target lobe volume reduction, spirometry changes and symptoms after BLVR. CLINICAL IMPLICATIONS: EIT is safe and feasible during BLVR, and may provide intraprocedural evidence of successful lobar occlusion. DISCLOSURES: No relevant relationships by Basit Azizi No relevant relationships by Elias Baedorf Kassis Consultant relationship with Boston Scientific Please note: $1001 - $5000 by Adnan Majid, value=Consulting fee Consultant relationship with olympus Please note: $5001 - $20000 by Adnan Majid, value=Consulting fee Consultant relationship with pinacle biologics Please note: $1001 - $5000 by Adnan Majid, value=Consulting fee No relevant relationships by Ricardo Munoz No relevant relationships by Mihir Parikh No relevant relationships by Maximilian Schaefer No relevant relationships by Aiman Suleiman No relevant relationships by Kai Swenson