Program Description
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.
Target Audience
Pulmonologists, critical care specialists, translational researchers, and clinicians
Learning Objectives
At the conclusion of this activity, learners should be able to:
- Describe the functioning of electrical impedance tomography (EIT)
- Describe the information provided by EIT
- Describe EIT’s potential application in daily clinical practice for the management of patients with acute respiratory failure
Course summary
1.00 Participation
1.00 AMA PRA Category 1 Credit
Credit Expires: March 15, 2027
Format: Journal
This section is not in use.
Please visit the Accreditation tab to view Accreditation and Disclosure information.
ACCREDITATION STATEMENT
The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
| Credit Type | Credit/Points | Credit Designation Statement |
| AMA PRA Category 1 Credit™ | 1.00 | The American Thoracic Society designates this Journal for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. |
DISCLOSURE DECLARATIONS
The current practice of the American Journal of Respiratory and Critical Care Medicine (AJRCCM) is to publish high quality, peer-reviewed and evidence-based original research, Concise Clinical Reviews, Guidelines and Consensus Statements. Articles published in AJRCCM include evidence-based summaries of optimal practice (Concise Clinical Reviews), evidence-based guidelines, workshop summaries and original contributions that will influence clinical practice. The publication of these articles by itself is only one piece of a multi-step process for the translation of evidence-based improvements in care to clinical practice. Articles selected for CME credit are designed to be the next step in the process of translating clinically relevant, evidence-based recommendations into clinical practice. This will be accomplished through a series of questions specifically designed by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AJRCCM editorial board will review these questions and assess the quality of the questions based on:
- Clarity,
- Educational content, and
- The quality of the evidence supporting the response to the question. Posttest questions will assess if practitioners have understood the most important recommendations available for the diagnosis and treatment of pulmonary diseases, critical illness, and sleep disorders and are able to implement them into clinical practice.
Article Authorship Disclosures (as submitted to the ATS prior to article publication date)
Guillaume Franchineau, M.D., Ph.D. (Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France) reported no relevant financial relationships with ineligible companies.
Annemijn H. Jonkman, Ph.D. (Erasmus Medical Center, Rotterdam, The Netherlands) reported no relevant financial relationships with ineligible companies.
Lise Piquilloud, M.D., Ph.D. (Lausanne University Hospital and Lausanne University, Lausanne, Switzerland) reported no relevant financial relationships with ineligible companies.
Takeshi Yoshida, M.D., Ph.D. (Osaka University Graduate School of Medicine, Osaka, Japan) reported no relevant financial relationships with ineligible companies.
Eduardo Costa, M.D., Ph.D. (University of São Paulo, Heart Institute, São Paulo, Brazil) reported consulting fees from Timpel.
Hadrien Rozé, M.D. (Bordeaux University Hospital, University of Bordeaux, and Réanimation Polyvalente, Centre Hospitalier Côte Basque, Bayonne, France) reported no relevant financial relationships with ineligible companies.
Luigi Camporota, M.D., Ph.D. (Health Centre for Human and Applied Physiological Sciences, Department of Adult Critical Care, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom) reported no relevant financial relationships with ineligible companies.
Thomas Piraino, R.R.T. (Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada and McMaster University, Hamilton, Ontario, Canada) reported no relevant financial relationships with ineligible companies.
Elena Spinelli, M.D. (Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy) reported no relevant financial relationships with ineligible companies.
Alain Combes, M.D., Ph.D. (Sorbonne Université, Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris Hôpital Pitié-Salpêtrière, Paris, France) reported grants from Getinge and personal fees from Getinge, Baxter, and Xenios outside the submitted work.
Glasiele C. Alcala, Ph.D. (University of São Paulo, Heart Institute, São Paulo, Brazil) reported no relevant financial relationships with ineligible companies.
Marcelo Amato, M.D., Ph.D. (University of São Paulo, Heart Institute, São Paulo, Brazil) reported no relevant financial relationships with ineligible companies.
Tommaso Mauri, M.D. (Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy and University of Milan, Milan, Italy) reported personal fees from Drager, Fisher & Paykel, and Mindray, outside of the submitted work.
Inéz Frerichs, M.D., Ph.D. (University Medical Centre of Schleswig-Holstein, Campus Kiel, Germany) reported no relevant financial relationships with ineligible companies.
Laurent Brochard, M.D. (Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada and McMaster University, Hamilton, Ontario, Canada) reported that his laboratory has received research grants from Medtronic, Draeger, Vitalaire, and Stimit, and equipment from Fisher & Paykel, Sentec, and Philips.
Matthieu Schmidt, M.D., Ph.D. (Sorbonne Université, Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris Hôpital Pitié-Salpêtrière, Paris, France) reported lecture fees from Getinge, Dräger, Baxter, and Fresenius Medical Care outside the submitted work.
Disclosures of AJRCCM CME Planners
The current practice of the American Journal of Respiratory and Critical Care Medicine (AJRCCM) is to publish high quality, peer-reviewed and evidence-based original research, Concise Clinical Reviews, Guidelines and Consensus Statements. Articles published in AJRCCM include evidence-based summaries of optimal practice (Concise Clinical Reviews), evidence-based guidelines, workshop summaries and original contributions that will influence clinical practice. The publication of these articles by itself is only one piece of a multi-step process for the translation of evidence-based improvements in care to clinical practice. Articles selected for CME credit are designed to be the next step in the process of translating clinically relevant, evidence-based recommendations into clinical practice. This will be accomplished through a series of questions specifically designed by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AJRCCM editorial board will review these questions and assess the quality of the questions based on (1) clarity, (2) educational content, and (3) the quality of the evidence supporting the response to the question. Posttest questions will assess if practitioners have understood the most important recommendations available for the diagnosis and treatment of pulmonary diseases, critical illness, and sleep disorders and are able to implement them into clinical practice.
Off-Label Usage Disclosure
None
AJRCCM CME Planners
Edward Schenck, M.D.
Associate Editor, AJRCCM
Dr. Schenck reported that he is a consultant for Axle Informatics
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