Monitoring perioperative changes in distribution of pulmonary ventilation by functional electrical impedance tomography

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Abstract
Background: Electrical impedance tomography (EIT) is a noninvasive technique providing cross‐sectional images of the thorax. We have tested an extended evaluation procedure, the functional EIT (f‐EIT), to identify the local shifts of ventilation known to occur during the transition between spontaneous, controlled and assisted ventilation modes. Methods: Ten patients scheduled for elective laparotomy were studied in the surgical ward, operating theatre and ICU during spontaneous and different modes of mechanical ventilation. Sixteen ECG electrodes were placed on the circumference of the thorax and connected with an EIT device (APT System Mark I, IBEES, Sheffield, UK). Measurements lasting 180 s were performed and f‐EIT images of regional ventilation computed. The geometrical centre of ventilation was determined to quantify the regional distribution of lung ventilation during individual modes of ventilation. Results: F‐EIT confirmed the differences in the distribution of ventilation associated with various modes of artificial ventilation. Accentuated ventilation of the dependent lung regions was observed during spontaneous breathing, whereas a shift of the centre of ventilation to the nondependent regions was found during controlled ventilation. In the course of assisted ventilation a continuous displacement of the centre of ventilation back towards the dependent lung regions, consistent with an increased proportion of spontaneous breathing, was detected. Unassisted spontaneous breathing after weaning from mechanical ventilation resulted in a similar ventilation distribution as during tidal breathing prior to surgery. Conclusion: F‐EIT determined the redistribution of lung ventilation during different modes of mechanical ventilation. We expect that f‐EIT will become a useful noninvasive bedside monitoring technique for imaging regional ventilation in pulmonary diseased patients during mechanical ventilation.