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

Area of Science:

• Medical Imaging
• Pediatric Critical Care
• Respiratory Physiology

Background:

• Electrical impedance tomography (EIT) offers continuous, real-time bedside visualization of regional lung ventilation and lung volume changes.
• Interest in EIT for monitoring critically ill neonates and young children with respiratory failure is high.
• Previous research on EIT in this population was limited to short-term studies with small sample sizes, leaving the feasibility and safety of prolonged monitoring unaddressed.

Purpose of the Study:

• To assess the feasibility and safety of long-term EIT monitoring in a routine clinical setting.
• To characterize changes in ventilation distribution and homogeneity over time and with different body positions in neonates and young children with respiratory failure.
• To evaluate EIT's utility in a large, multicenter cohort.

Main Methods:

• An observational study involving 200 neonates and young children (postmenstrual age 25 weeks to 36 months) with respiratory failure was conducted across four European university hospitals.
• Continuous EIT data were collected using a novel textile 32-electrode interface for up to 72 hours at 48 images/s.
• Clinicians were blinded to EIT images during monitoring; EIT parameters and positional effects on ventilation were analyzed offline.

Main Results:

• EIT monitoring averaged 53 ± 20 hours, with valid image reconstruction achieved for a median of 92% of the time.
• The procedure was well-tolerated, with only minor skin irritations in 10% of patients and no severe adverse events.
• Ventilation amplitude was higher dorsally and on the right; prone positioning increased dorsal ventilation, while lateral positioning redistributed ventilation based on postmenstrual age.

Conclusions:

• Continuous EIT monitoring for up to 72 hours is feasible and safe in neonates and young children, with minimal adverse effects.
• The study confirmed posture-dependent ventilation distribution changes in a large cohort.
• Ventilation distribution is influenced by postmenstrual age and body positioning in this patient group.