TY - JOUR
T1 - Prolonged Continuous Monitoring of Regional Lung Function in Infants with Respiratory Failure
AU - Becher, Tobias H.
AU - Miedema, Martijn
AU - Kallio, Merja
AU - Papadouri, Thalia
AU - Karaoli, Christina
AU - Sophocleous, Louiza
AU - Rahtu, Marika
AU - van Leuteren, Ruud W.
AU - Waldmann, Andreas D.
AU - Strodthoff, Claas
AU - Yerworth, Rebecca
AU - Dupré, Antoine
AU - Benissa, Mohamed-Rida
AU - Nordebo, Sven
AU - Khodadad, Davood
AU - Bayford, Richard
AU - Vliegenthart, Roseanne
AU - Rimensberger, Peter C.
AU - van Kaam, Anton H.
AU - Frerichs, Inéz
N1 - Funding Information: Supported by the European Union’s Horizon 2020 Research and Innovation Programme under grant agreement 668259 and by the Swiss State Secretariat for Education, Research and Innovation (SERI) under contract number 15.0342-1. M.K. was funded by the Finnish Foundation for Pediatric Research. Publisher Copyright: Copyright © 2022 by the American Thoracic Society
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Rationale: Electrical impedance tomography (EIT) allows instantaneous and continuous visualization of regional ventilation and changes in end-expiratory lung volume at the bedside. There is particular interest in using EIT for monitoring in critically ill neonates and young children with respiratory failure. Previous studies have focused only on short-term monitoring in small populations. The feasibility and safety of prolonged monitoring with EIT in neonates and young children have not been demonstrated yet. Objectives: To evaluate the feasibility and safety of long-term EIT monitoring in a routine clinical setting and to describe changes in ventilation distribution and homogeneity over time and with positioning in a multicenter cohort of neonates and young children with respiratory failure. Methods: At four European University hospitals, we conducted an observational study (NCT02962505) on 200 patients with postmenstrual ages (PMA) between 25 weeks and 36 months, at risk for or suffering from respiratory failure. Continuous EIT data were obtained using a novel textile 32-electrode interface and recorded at 48 images/s for up to 72 hours. Clinicians were blinded to EIT images during the recording. EIT parameters and the effects of body position on ventilation distribution were analyzed offline. Results: The average duration of EIT measurements was 53 6 20 hours. Skin contact impedance was sufficient to allow image reconstruction for valid ventilation analysis during a median of 92% (interquartile range, 77–98%) of examination time. EIT examinations were well tolerated, with minor skin irritations (temporary redness or imprint) occurring in 10% of patients and no moderate or severe adverse events. Higher ventilation amplitude was found in the dorsal and right lung areas when compared with the ventral and left regions, respectively. Prone positioning resulted in an increase in the ventilation-related EIT signal in the dorsal hemithorax, indicating increased ventilation of the dorsal lung areas. Lateral positioning led to a redistribution of ventilation toward the dependent lung in preterm infants and to the nondependent lung in patients with PMA . 37 weeks. Conclusions: EIT allows continuous long-term monitoring of regional lung function in neonates and young children for up to 72 hours with minimal adverse effects. Our study confirmed the presence of posture-dependent changes in ventilation distribution and their dependency on PMA in a large patient cohort.
AB - Rationale: Electrical impedance tomography (EIT) allows instantaneous and continuous visualization of regional ventilation and changes in end-expiratory lung volume at the bedside. There is particular interest in using EIT for monitoring in critically ill neonates and young children with respiratory failure. Previous studies have focused only on short-term monitoring in small populations. The feasibility and safety of prolonged monitoring with EIT in neonates and young children have not been demonstrated yet. Objectives: To evaluate the feasibility and safety of long-term EIT monitoring in a routine clinical setting and to describe changes in ventilation distribution and homogeneity over time and with positioning in a multicenter cohort of neonates and young children with respiratory failure. Methods: At four European University hospitals, we conducted an observational study (NCT02962505) on 200 patients with postmenstrual ages (PMA) between 25 weeks and 36 months, at risk for or suffering from respiratory failure. Continuous EIT data were obtained using a novel textile 32-electrode interface and recorded at 48 images/s for up to 72 hours. Clinicians were blinded to EIT images during the recording. EIT parameters and the effects of body position on ventilation distribution were analyzed offline. Results: The average duration of EIT measurements was 53 6 20 hours. Skin contact impedance was sufficient to allow image reconstruction for valid ventilation analysis during a median of 92% (interquartile range, 77–98%) of examination time. EIT examinations were well tolerated, with minor skin irritations (temporary redness or imprint) occurring in 10% of patients and no moderate or severe adverse events. Higher ventilation amplitude was found in the dorsal and right lung areas when compared with the ventral and left regions, respectively. Prone positioning resulted in an increase in the ventilation-related EIT signal in the dorsal hemithorax, indicating increased ventilation of the dorsal lung areas. Lateral positioning led to a redistribution of ventilation toward the dependent lung in preterm infants and to the nondependent lung in patients with PMA . 37 weeks. Conclusions: EIT allows continuous long-term monitoring of regional lung function in neonates and young children for up to 72 hours with minimal adverse effects. Our study confirmed the presence of posture-dependent changes in ventilation distribution and their dependency on PMA in a large patient cohort.
KW - electrical impedance tomography
KW - infant respiratory distress syndrome
KW - monitoring of mechanical ventilation
KW - neonatal critical care
KW - pediatric critical care
UR - http://www.scopus.com/inward/record.url?scp=85131268327&partnerID=8YFLogxK
U2 - https://doi.org/10.1513/AnnalsATS.202005-562OC
DO - https://doi.org/10.1513/AnnalsATS.202005-562OC
M3 - Article
C2 - 34898392
SN - 2325-6621
VL - 19
SP - 991
EP - 999
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 6
ER -