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Prolonged Continuous Monitoring of Regional Lung Function in Infants with Respiratory Failure

Becher, TH; Miedema, M; Kallio, M; Papadouri, T; Karaoli, C; Sophocleous, L; Rahtu, M; ... Frerichs, I; + view all (2022) Prolonged Continuous Monitoring of Regional Lung Function in Infants with Respiratory Failure. Annals of the American Thoracic Society , 19 (6) pp. 991-996. 10.1513/AnnalsATS.202005-562OC. Green open access

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Abstract

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 has 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 multi-center 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 post-menstrual 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±20 hours. Skin contact impedance was sufficient to allow image reconstruction for valid ventilation analysis during 92[77-98]% (median[interquartile range]) 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 towards the dependent lung in preterm infants and to the non-dependent lung in patients with PMA above 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.

Type: Article
Title: Prolonged Continuous Monitoring of Regional Lung Function in Infants with Respiratory Failure
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1513/AnnalsATS.202005-562OC
Publisher version: https://doi.org/10.1513/AnnalsATS.202005-562OC
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: electrical impedance tomography; monitoring of mechanical ventilation; infant respiratory distress syndrome; neonatal critical care; pediatric critical care
UCL classification: UCL
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Med Phys and Biomedical Eng
URI: https://discovery.ucl.ac.uk/id/eprint/10140887
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