Thoracic Electrical Impedance Research Articles

Assessing pulmonary function in ALS using electrical impedance tomography

Objective: We sought to determine whether thoracic electrical impedance tomography (EIT) could characterize pulmonary function in amyotrophic lateral sclerosis (ALS) patients, including those with facial weakness. Thoracic EIT is a noninvasive, technology in which a multi-electrode belt is placed across the chest, producing real-time impedance imaging of the chest during breathing. Methods: We enrolled 32 ALS patients and 32 age- and sex-matched healthy controls (HCs) without underlying lung disease. All participants had EIT measurements performed simultaneously with standard pulmonary function tests (PFTs), including slow and forced vital capacity (SVC and FVC) in upright and supine positions and maximal inspiratory and expiratory pressures (MIPs and MEPs, respectively). Intraclass correlation coefficients (ICCs) were calculated to assess the immediate reproducibility of EIT measurements and Pearson’s correlations were used to explore the relationships between EIT and PFT values. Results: Data from 30 ALS patients and 27 HCs were analyzed. Immediate upright SVC reproducibility was very high (ICC 0.98). Correlations were generally strongest between EIT and spirometry measures, with R values ranging from 0.64 to 0.82 (p < 0.001) in the ALS cohort. There were less robust correlations between EIT values and both MIPs and MEPs in the ALS patients, with R values ranging from 0.33 to 0.44. There was no significant difference for patients with and without facial weakness. There were no reported adverse events. Conclusion: EIT-based pulmonary measures hold the promise of providing an alternative approach for lung function assessment in ALS patients. Based on these early results, further development and study of this technology are warranted.

Validation of three-dimensional thoracic electrical impedance tomography of horses during normal and increased tidal volumes

Objective. Data from two-plane electrical impedance tomography (EIT) can be reconstructed into various slices of functional lung images, allowing for more complete visualisation and assessment of lung physiology in health and disease. The aim of this study was to confirm the ability of 3D EIT to visualise normal lung anatomy and physiology at rest and during increased ventilation (represented by rebreathing). Approach. Two-plane EIT data, using two electrode planes 20 cm apart, were collected in 20 standing sedate horses at baseline (resting) conditions, and during rebreathing. EIT data were reconstructed into 3D EIT whereby tidal impedance variation (TIV), ventilated area, and right-left and ventral-dorsal centres of ventilation (CoVRL and CoVVD, respectively) were calculated in cranial, middle and caudal slices of lung, from data collected using the two planes of electrodes. Main results. There was a significant interaction of time and slice for TIV (p < 0.0001) with TIV increasing during rebreathing in both caudal and middle slices. The ratio of right to left ventilated area was higher in the cranial slice, in comparison to the caudal slice (p = 0.0002). There were significant effects of time and slice on CoVVD whereby the cranial slice was more ventrally distributed than the caudal slice (p < 0.0009 for the interaction). Significance. The distribution of ventilation in the three slices corresponds with topographical anatomy of the equine lung. This study confirms that 3D EIT can accurately represent lung anatomy and changes in ventilation distribution during rebreathing in standing sedate horses.

Rapid patient-specific FEM meshes from 3D smart-phone based scans

Objective. The objective of this study was to describe and evaluate a smart-phone based method to rapidly generate subject-specific finite element method (FEM) meshes. More accurate FEM meshes should lead to more accurate thoracic electrical impedance tomography (EIT) images. Approach. The method was evaluated on an iPhone® that utilized an app called Heges, to obtain 3D scans (colored, surface triangulations), a custom belt, and custom open-source software developed to produce the subject-specific meshes. The approach was quantitatively validated via mannequin and volunteer tests using an infrared tracker as the gold standard, and qualitatively assessed in a series of tidal-breathing EIT images recorded from 9 subjects. Main results. The subject-specific meshes can be generated in as little as 6.3 min, which requires on average 3.4 min of user interaction. The mannequin tests yielded high levels of precision and accuracy at 3.2 ± 0.4 mm and 4.0 ± 0.3 mm root mean square error (RMSE), respectively. Errors on volunteers were only slightly larger (5.2 ± 2.1 mm RMSE precision and 7.7 ± 2.9 mm RMSE accuracy), illustrating the practical RMSE of the method. Significance. Easy-to-generate, subject-specific meshes could be utilized in the thoracic EIT community, potentially reducing geometric-based artifacts and improving the clinical utility of EIT.

Thoracic electrical impedance tomography identifies heterogeneity in lungs associated with respiratory disease in cattle. A pilot study.

Respiratory disease in cattle is a significant global concern, yet current diagnostic methods are limited, and there is a lack of crush-side tests for detecting active disease. To address this gap, we propose utilizing electrical impedance tomography (EIT), a non-invasive imaging technique that provides real-time visualization of lung ventilation dynamics. The study included adult cattle from farms in Western Australia. The cattle were restrained in a crush. A standardized respiratory scoring system, which combined visual, auscultation, and clinical scores, was conducted by two non-conferring clinicians for each animal. The scores were blinded and averaged. During assessment, an EIT electrode belt was placed around the thorax. EIT recordings of ten suitable breaths were taken for analysis before the cattle were released back to the herd. Based on the combined examination scoring, the cattle were categorized as having healthy or diseased lungs. To allow visual interpretation of each breath and enable the creation of the quartile ventilation ratio (VQR), Flow/Tidal Impedance Variation curves (F/TIV) were generated for each breath. The analysis focused on two EIT variables: The novel VQR over time during inhalation and exhalation and global expiratory impedance (TIVEXP) adjusted by breath length. A mixed effects model was used to compare these variables between healthy and diseased cattle. Ten adult cattle of mixed ages were used in the current analysis. Five cattle were scored as healthy and five as diseased. There was a significant difference in the examination scores between the healthy and diseased group (P = 0.03). A significant difference in VQR during inhalation (P = 0.03) was observed between the healthy and diseased groups. No difference was seen in VQR over time during exhalation (P = 0.3). The TIVEXP was not different between groups (P = 0.36). In this study, EIT was able to detect differences in inhalation mechanics when comparing healthy and diseased cattle as defined via clinical examination, highlighting the clinical utility of EIT.

Machine learning-based signal quality assessment for cardiac volume monitoring in electrical impedance tomography

Owing to recent advances in thoracic electrical impedance tomography (EIT), a patient’s hemodynamic function can be noninvasively and continuously estimated in real-time by surveilling a cardiac volume signal (CVS) associated with stroke volume and cardiac output. In clinical applications, however, a CVS is often of low quality, mainly because of the patient’s deliberate movements or inevitable motions during clinical interventions. This study aims to develop a signal quality indexing method that assesses the influence of motion artifacts on transient CVSs. The assessment is performed on each cardiac cycle to take advantage of the periodicity and regularity in cardiac volume changes. Time intervals are identified using the synchronized electrocardiography system. We apply divergent machine-learning methods, which can be sorted into discriminative-model and manifold-learning approaches. The use of machine-learning could be suitable for our real-time monitoring application that requires fast inference and automation as well as high accuracy. In the clinical environment, the proposed method can be utilized to provide immediate warnings so that clinicians can minimize confusion regarding patients’ conditions, reduce clinical resource utilization, and improve the confidence level of the monitoring system. Numerous experiments using actual EIT data validate the capability of CVSs degraded by motion artifacts to be accurately and automatically assessed in real-time by machine learning. The best model achieved an accuracy of 0.95, positive and negative predictive values of 0.96 and 0.86, sensitivity of 0.98, specificity of 0.77, and AUC of 0.96.

Determination of tidal volume by electrical impedance tomography (EIT) after indirect two-point calibration

Objective. A linear relationship between impedance change (ΔZ) measured by thoracic electrical impedance tomography (EIT) and tidal volume (VT) has been demonstrated. This study evaluated the agreement between the displayed VT calculated by the EIT software (VTEIT) and spirometry (VTSPIRO) after an indirect two-point calibration. Approach. The EIT software was programmed to execute a bedside two-point calibration from the subject-specific, linear equation defining the relationship between ΔZ and VTSPIRO and displaying VTEIT breath-by-breath in 20 neutered male, juvenile pigs. After EIT calibration VTs of 8, 12, 16 and 20 ml kg−1 were applied to the lungs. VTEIT and VTSPIRO were recorded and analysed using Bland–Altman plot for multiple subject measurements. Volumetric capnography (VCap) and spirometry data were explored as components of variance using multiple regression. Main results. A mean relative difference (bias) of 0.7% with 95% confidence interval (CI) of −10.4% to 10.7% were found between VTEIT and VTSPIRO for the analysed data set. The variance in VTEIT could not be explained by any of the measured VCap or spirometry variables. Significance. The narrow CI estimated in this study allows the conclusion that EIT and its software can be used to measure and accurately convert ΔZ into mililitre VT at the bedside after applying an indirect two-point calibration.

Objective Assessment of Physiologic Alterations Associated With Hemodynamically Significant Patent Ductus Arteriosus in Extremely Premature Neonates.

Delay in closure of ductus arteriosus in postnatal life may lead to serious consequences and complications in an extremely premature neonate secondary to hemodynamic alterations in regional blood flow pattern in various organs. Despite the widespread recognition amongst neonatologists to identify a hemodynamically significant patent ductus arteriosus (hsPDA) early in the postnatal course, there is lack of consensus in its definition and thus the threshold to initiate treatment. Echocardiographic assessment of PDA shunt size and volume combined with neonatologists' impression of clinical significance is most frequently used to determine the need for treatment of PDA. Common clinical signs of hsPDA utilized as surrogate for decreased tissue perfusion may lag behind early echocardiographic signs. Although echocardiogram allows direct assessment of PDA shunt and hemodynamic alterations in the heart, it is limited by dependence on pediatric cardiologist availability, interobserver variation and isolated time point assessment. Electrical cardiometry (EC) is a non-invasive continuous real time measurement of cardiac output by applying changes in thoracic electrical impedance. EC has been validated in preterm newborns by concomitant transthoracic echocardiogram assessments and may be beneficial in studying changes in cardiac output in premature newborns with hsPDA. Alterations in perfusion index derived from continuous pulse oximetry monitoring has been used to study changes in cardiac performance and tissue perfusion in infants with PDA. Near infrared spectroscopy (NIRS) has been used to objectively and continuously assess variations in renal, mesenteric, and cerebral oxygen saturation and thus perfusion changes due to diastolic vascular steal from hsPDA in preterm neonates. Doppler ultrasound studies measuring resistive indices in cerebral circulation indicate disturbance in cerebral perfusion secondary to ductal steal. With recent trends of change in practice toward less intervention in care of preterm newborn, treatment strategy needs to be targeted for select preterm population most vulnerable to adverse hemodynamic effects of PDA. Integration of these novel ways of hemodynamic and tissue perfusion assessment in routine clinical care may help mitigate the challenges in defining and targeting treatment of hsPDA thereby improving outcomes in extremely premature neonates.

The central blood volume as measured by thoracic electrical impedance and plasma proANP is not compromised by donation of 900 mL of blood in men.

To evaluate whether the donation of 900 mL of blood reduces the central blood volume (CBV) assessed by thoracic electrical impedance (TI) and plasma pro-atrial natriuretic peptide (proANP). Donation of 450 mL of blood carries a 1% risk of a vasovagal reaction. Withdrawal of 900 mL of blood decreases cardiac output; however, the effect on CBV remains unknown. A randomised, single-blinded, placebo-controlled, crossover design was used, where 21 healthy semi-recumbent men donated 2 × 450 mL blood or were sham-phlebotomised. Changes in CBV were estimated by proANP and TI at 1.5 (TI1.5 ) and 100 (TI100 ) kHz, reflecting extracellular volume and (regional) total body water, respectively, and the index value (IDX; 1/T1.5 -1/TI100 ) was used to estimate changes in intracellular (red cell) volume. Systolic, diastolic and mean arterial blood pressure; heart rate; stroke volume; cardiac output; and systemic vascular resistance were monitored. After completion of the study, 1000 mL of isotonic saline was infused. Changes (mean% ± SD) in TI1.5 , TI100 and IDX were similar after 450 mL (-0.2 ± 1.6%, 0.0 ± 1.1%, -0.4 ± 10.1%) and 900 mL (0.1 ± 1.6%, 0.2 ± 1.5% and -2.0 ± 15.8%) of blood donation compared to after a sham donation of 450 mL (-0.9 ± 1.2%, -0.5 ± 1.5% and -0.1 ± 6.1%) and 900 mL (-1.2 ± 1.5%, -0.6 ± 1.3% and 0.5 ± 9.9%). In addition, changes in plasma proANP were similar after 450 and 900 mL of blood donation (-0.8 ± 6.7% and -7.6 ± 7.9%) as after sham donations (1.3 ± 7.3% and -4.5 ± 5.6%). Monitoring haemodynamic variables revealed that stroke volume decreased after the donation of 900 mL of blood (-12 ± 12 mL) compared to sham donations. During a 900-mL blood loss in semi-recumbent men, CBV measured by TI and plasma proANP is not affected.

Cardiac eigen imaging: a novel method to isolate cardiac activity in thoracic electrical impedance tomography

Objective: As the global burden of cardiovascular disease increases, proactive cardiovascular healthcare by means of accurate, precise, continuous, and non-invasive monitoring is becoming crucial. However, no current device is able to provide cardiac hemodynamic monitoring with the aforementioned criterion. Electrical impedance tomography (EIT) is an inexpensive, non-invasive imaging modality that can provide real-time images of internal conductivity distributions that describe physiological activity. This work explores and compares a standard approach of regular cardiac gated averaging (RCGA) and a newly developed method, cardiac eigen-imaging (CEI), based on the singular value decomposition (SVD) to isolate cardiac activity in thoracic EIT. Approach: EIT and heart-rate (HR) data were collected from 20 heart-failure patients preceding echocardiography. Features from RCGA and CEI images were correlated with stroke volume (SV) from echocardiography and image reconstruction parameters were optimized using leave-one-out (LOO) cross-validation. Main results: CEI per-pixel-based features achieved a Pearson correlation coefficient of 0.80 with SV relative to 0.72 with RCGA. CEI had 33 high-correlating pixels while RCGA had 8. High-correlating pixels tend to concentrate in the right-ventricle (RV) when referenced to a general chest model. Significance: While both RCGA and CEI images had high-correlating pixels, CEI had higher correlations, a larger number of high-correlating pixels, and unlike RCGA is not dependent on the quality of the HR data collected. The observed performance of the CEI approach represents a promising step forward for EIT-based cardiac monitoring in either clinical or ambulatory settings.

A robust and novel electrical impedance metric of pulmonary function in ALS patients

Objective: Pulmonary function tests (PFTs) are important for assessing respiratory function in amyotrophic lateral sclerosis (ALS) patients. However, weakness of oral and glottal closure, due to concomitant bulbar dysfunction, may result in unreliable PFT values stemming from leakage of air around the breathing tube and through the glottis. In this study, we assessed whether standard thoracic electrical impedance tomography (EIT) could serve as a surrogate measure for PFTs. Approach: Thoracic EIT was performed simultaneously with standard PFTs on seven ALS patients without clinical bulbar weakness (six men and one woman, mean age of 63 years) and ten healthy volunteers (seven men and three women, mean age of 57 years). A raw impedance metric along with more standard EIT measures were computed and correlated with the normalized forced vital capacity (FVC). Additionally, test/re-test metrics and EIT images were analyzed. Main results: The impedance metric was found to be robust and sensitive to lung activity. We also identified qualitative EIT differences between healthy volunteers and ALS patients, with the ALS images showing greater heterogeneity. Significant correlations with FVC were found for both impedance and EIT metrics in ALS patients (r2 = 0.89) and for the impedance metric only in healthy volunteers (r2 = 0.49). Significance: This suggests that EIT, using our novel impedance metric, has the potential to serve as an alternative technology to standard PFTs for assessing pulmonary function in patients with ALS, offering new metrics of disease status for those with bulbar weakness.

Realistic forward and inverse model mesh generation for rapid three-dimensional thoracic electrical impedance imaging

One of the most promising clinical applications of Electrical Impedance Tomography (EIT) is real-time monitoring of lung function in ambulatory or ICU due to the rapid, non-invasive and non-ionizing nature of the measurements. However, to move this modality into routine clinical use will, as a minimum, require the development of realistic and computationally efficient forward and inverse meshes of the thorax and the lungs alongside mechanisms to extract quantitative information from the resulting reconstructed images. The latter will allow for reduction of artefacts and better localization of conductivity changes within the image domain. This research aims to contribute towards this goal, by introducing a pipeline for the generation of anatomically accurate meshes for EIT forward and inverse models. We achieve this by the segmentation of realistic volumetric data from thoracic CT volumes, and subsequent tessellation. Mesh quality is assessed in terms of aspect ratio, dihedral and face angles. Moreover, the generated meshes are fused with currently available EIT software, with a novel electrode placement method, to show the practical application of the generated meshes. Results show that anatomically constrained unstructured meshes can be generated, conforming to realistic anatomical geometry, and performing well in EIT numerical computations. Such realistic computational models will further enhance the performance of EIT reconstruction algorithms, thus offering significant benefits to clinical EIT lung imaging.

Unconstrained Cardiac Output Measurement System Based on Thoracic Electrical Impedance Method

An unconstrained cardiac output detection system based on thoracic electrical impedance method and embedded technology is developed in this study. PWM function of PIC embedded MCU, PIC18F4520, and filter circuit are used to generate a constant current sinusoidal signal with a frequency of 50 kHz and a current RMS of 2 mArms, which is applied as an exciting signal to the exciting electrodes located on the positions behind ears and on right lower abdomen. The thoracic electrical impedance is measured by the detecting electrodes pasted along the medial line on the front of the thorax, and is used to calculate cardiac output. A comparative experiment with the thoracic impedance method and the dye dilution method is carried out and the results are investigated. The experimental results show that the two methods have good consistency.

The impedance cardiography technique in medical diagnosis

Background: Thoracic Electrical Bioimpedance (TEB) Technology sometimes called the Impedance Cardiography (ICG). In 1940, the Impedance Cardiography emerged; the studies of this technique are realized to the cardiovascular diseases detection which used hemodynamic parameters measurements based on the skin electrodes contact by injecting a low amplitude alternating signal. The objective of this article is to review the various studies based on this signal type and to present the multiple methods used for the treatment and to have a correct analysis.&#x0D; Methods: This ICG technique consists for applying an electric field longitudinally across a segment of the thorax with amplitude in mean, high frequency and low amplitude current. To analyze the ICG signal, the signal denoising is necessary that’s why a multiple filters are proposed, and the Discrete Wavelet Transform (DWT) denoising is also used.&#x0D; Results: The ICG is considered advantageous compared to other invasive conventional techniques; it gives a good correlation, and solves the Doppler ultrasound and Thermodilution problems. According to the studies, the Daubechies wavelet family (db8) is the best DWT to eliminate the noises. There are several algorithms for the signal characteristic point’s detection.&#x0D; Conclusion: For the purpose of cardiovascular disease diagnosis and monitoring, the non-invasive ICG technique comes to solve the complexity problem for measurement and analyzing heart disease based on the thoracic electrical impedance change assessment that is due to blood velocity and resistivity changes (blood volume changes) in order to estimate several hemodynamic parameters.&#x0D; Keywords: ICG, cardiovascular disease, hemodynamic parameters, diagnosis and monitoring, correct analysis.&#x0D;

Electrical Impedance Tomography for Confirmation of Lung Isolation during One-lung Ventilation.

One-lung ventilation is regularly performed to facilitate thoracic surgical procedures during general anesthesia. The adequacy of one-lung ventilation following placement of a double-lumen endotracheal tube was verified by auscultation and intermittent fiberoptic bronchoscopy. In addition, we continuously monitored one-lung ventilation by electrical impedance tomography,1 which is a noninvasive, radiation-free bedside method that continuously displays regional distribution of ventilation and may help to optimize ventilation during general anesthesia.2 Electrical impedance tomography measurements require a belt with electrodes around the patient’s chest (top image). In brief, axial images are reconstructed from impedance changes induced by very small alternating electrical currents, that are applied through pairs of electrodes.Images A–D show thoracic electrical impedance tomography images. The blue shapes show summarized tidal changes due to ventilation and the dots are a schematic representation of the electrodes surrounding the thorax.Image A shows electrical impedance tomography during deep spontaneous breathing with ventilation throughout both lungs. Image B illustrates the ventral shift of ventilation in both lungs with collapse of dependent lung areas, during manual ventilation after induction of anesthesia.3 Image C confirms correct lung separation by lack of ventilation signals of the left lung. Finally, image D shows ventilation of both lungs following resumption of spontaneous breathing after discontinuing anesthesia. Electrical impedance tomography may be a helpful monitoring tool during one-lung ventilation.Dr. Wrigge received consultancy fees from Dräger Medical, Lübeck, Germany; funding and lecture fees from InfectoPharm, Heppenheim, Germany; and lecture fees from MSD, Konstanz, Germany. The other authors declare no competing interests.

Mechanical ventilation guided by electrical impedance tomography in pediatric acute respiratory distress syndrome

Mechanical ventilation strategies in pediatric acute respiratory distress syndrome (pARDS) continue to advance. Optimizing positive end expiratory pressure (PEEP) and ventilation to recruitable lung can be difficult to clinically achieve. This is in part, due to disease evolution, unpredictable changes in lung compliance, and the inability to assess regional tidal volumes in real time at the bedside. Here we report the utilization of thoracic electrical impedance tomography to guide daily PEEP settings and recruitment maneuvers in a child with pARDS.

Assessment of distribution of ventilation and regional lung compliance by electrical impedance tomography in anaesthetized horses undergoing alveolar recruitment manoeuvres

ObjectiveTo examine changes in the distribution of ventilation and regional lung compliances in anaesthetized horses during the alveolar recruitment manoeuvre (ARM). Study designExperimental study in which a series of treatments were administered in a fixed order on one occasion. AnimalsFive adult Warmblood horses. MethodsAnimals were anaesthetized (xylazine, midazolam–ketamine, isoflurane), placed in dorsal recumbency and ventilated with 100% oxygen using peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP) of 20 cmH2O and 0 cmH2O, respectively. Thoracic electrical impedance tomography (EIT), spirometry and routine anaesthesia monitoring were performed. At 90 minutes after induction of anaesthesia, PIP and PEEP were increased in steps of 5 cmH2O to 50 cmH2O and 30 cmH2O, respectively, and then decreased to baseline values. Each step lasted 10 minutes. Data were recorded and functional EIT images were created using three breaths at the end of each step. Arterial blood samples were analysed. Values for left-to-right and sternal-to-dorsal centre of ventilation (COV), lung compliances and Bohr dead space were calculated. ResultsDistribution of ventilation drifted leftward and dorsally during recruitment. Mean±standard deviation (SD) values at baseline and highest airway pressures, respectively, were 49.9±0.7% and 48.0±0.6% for left-to-right COV (p=0.009), and 46.3±2.0% and 54.6±2.0% for sternal-to-dorsal COV (p=0.0001). Compliance of dependent lung regions and PaO2 increased, whereas compliance of non-dependent lung regions decreased during ARM and then returned to baseline (p<0.001). Bohr dead space decreased after ARM (p=0.007). Interestingly, PaO2 correlated to the compliance of the dependent lung (r2=0.71, p<0.001). Conclusions and clinical relevanceThe proportion of tidal volume distributed to dependent and left lung regions increased during ARM, presumably as a result of opening atelectasis. Monitoring compliance of the dependent lung with EIT may substitute PaO2 measurements during ARM to identify an optimal PEEP.

Electrical impedance tomography for non-invasive assessment of stroke volume variation in health and experimental lung injury

BackgroundFunctional imaging by thoracic electrical impedance tomography (EIT) is a non-invasive approach to continuously assess central stroke volume variation (SVV) for guiding fluid therapy. The early available data were from healthy lungs without injury-related changes in thoracic impedance as a potentially influencing factor. The aim of this study was to evaluate SVV measured by EIT (SVVEIT) against SVV from pulse contour analysis (SVVPC) in an experimental animal model of acute lung injury at different lung volumes. MethodsWe conducted a randomized controlled trial in 30 anaesthetized domestic pigs. SVVEIT was calculated automatically analysing heart–lung interactions in a set of pixels representing the aorta. Each initial analysis was performed automatically and unsupervised using predefined frequency domain algorithms that had not previously been used in the study population. After baseline measurements in normal lung conditions, lung injury was induced either by repeated broncho-alveolar lavage (n=15) or by intravenous administration of oleic acid (n=15) and SVVEIT was remeasured. ResultsThe protocol was completed in 28 animals. A total of 123 pairs of SVV measurements were acquired. Correlation coefficients (r) between SVVEIT and SVVPC were 0.77 in healthy lungs, 0.84 after broncho-alveolar lavage, and 0.48 after lung injury from oleic acid. ConclusionsEIT provides automated calculation of a dynamic preload index of fluid responsiveness (SVVEIT) that is non-invasively derived from a central haemodynamic signal. However, alterations in thoracic impedance induced by lung injury influence this method.

Regional distribution of ventilation in patients with obstructive sleep apnea: the role of thoracic electrical impedance tomography (EIT) monitoring.

The aim of our study was to apply the electrical impedance tomography (EIT) technique to the study of ventilation during wake and NREM and REM sleep in patients with obstructive sleep apneas (OSA). This is a prospective, observational, monocentric, pilot study in a neurology department with a sleep disorder center. Inclusion criteria were age ≥18years, both gender, and diagnosis of OSA. Exclusion criteria were the contraindications to the thoracic EIT. All patients underwent laboratory-based polysomnography (PSG) alongside thoracic EIT. Primary endpoint was to compare the global impedance (GI) among the conditions: "Wake" vs "Sleep," "NREM" vs "REM," and "OSA" vs "Non-OSA." Secondary endpoint was to measure the regional distribution of impedance in the four regions of interest (ROIs), in each condition. Of the 17 consecutive patients enrolled, two were excluded because of poor-quality EIT tracings. Fifteen were analyzed, 10 men and 5 women, mean age 51.6±14.4years. GI was higher in Wake vs Sleep (Wake 13.24±11.23; Sleep 12.56±13.36; p<0.01), in NREM vs REM (NREM 13.48±13.43; REM 0.59±0.01; p<0.01), and in Non-OSA vs OSA (Non-OSA 10.50±12.99; OSA 18.98±10.06; p<0.01). No significant differences were observed in the regional distribution of impedance between Wake and Sleep (χ 2=3.66; p=0.299) and between Non-OSA and OSA (χ 2=1.00; p=0.799); conversely, a significant difference was observed between NREM and REM sleep (χ 2=62.94; p<0.001). To our knowledge, this is the first study that addresses the issue of regional ventilation in OSA patients during sleep. Thoracic electrical impedance changes through the sleep-wake cycle and during obstructive events. The application of thoracic EIT can prove a valuable additional strategy for the evaluation of OSA patients.

Electrical impedance tomography (EIT) for quantification of pulmonary edema in acute lung injury

BackgroundAssessment of pulmonary edema is a key factor in monitoring and guidance of therapy in critically ill patients. To date, methods available at the bedside for estimating the physiologic correlate of pulmonary edema, extravascular lung water, often are unreliable or require invasive measurements. The aim of the present study was to develop a novel approach to reliably assess extravascular lung water by making use of the functional imaging capabilities of electrical impedance tomography.MethodsThirty domestic pigs were anesthetized and randomized to three different groups. Group 1 was a sham group with no lung injury. Group 2 had acute lung injury induced by saline lavage. Group 3 had vascular lung injury induced by intravenous injection of oleic acid. A novel, noninvasive technique using changes in thoracic electrical impedance with lateral body rotation was used to measure a new metric, the lung water ratioEIT, which reflects total extravascular lung water. The lung water ratioEIT was compared with postmortem gravimetric lung water analysis and transcardiopulmonary thermodilution measurements.ResultsA significant correlation was found between extravascular lung water as measured by postmortem gravimetric analysis and electrical impedance tomography (r = 0.80; p < 0.05). Significant changes after lung injury were found in groups 2 and 3 in extravascular lung water derived from transcardiopulmonary thermodilution as well as in measurements derived by lung water ratioEIT.ConclusionsExtravascular lung water could be determined noninvasively by assessing characteristic changes observed on electrical impedance tomograms during lateral body rotation. The novel lung water ratioEIT holds promise to become a noninvasive bedside measure of pulmonary edema.

Contact impedances of textile electrodes for electrical impedance tomography

In thoracic electrical impedance tomography (EIT) electrodes are placed around the human thorax. Weak alternating currents are applied via two electrodes and the resulting potentials are sensed by the remaining electrodes. The measured voltages are then converted into moving real-time images showing heart and lung functions rather than its structures. EIT is non-invasive and can thus be employed over several hours right at the bedside. However, for mid and long term measurements stable electrical electrode skin contact and a skin friendly patient interface are required.