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Monitoring Lung Function with Electrical Impedance Tomography in the Intensive Care Unit
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Regional lung perfusion using different indicators in electrical impedance tomography.

Timothy G Gaulton1, Kevin Martin1, Yi Xin1

  • 1Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, United States.

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|July 13, 2023
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Sodium bicarbonate may be a viable alternative to hypertonic saline for measuring lung perfusion with electrical impedance tomography. This finding could improve bedside monitoring for patients with acute respiratory distress syndrome (ARDS).

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acute respiratory distress syndromeelectrical impedance tomographypulmonary blood flow

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Area of Science:

  • Critical Care Medicine
  • Pulmonary Physiology
  • Medical Imaging Technology

Background:

  • Acute respiratory distress syndrome (ARDS) management focuses on lung protection and mechanical ventilation, but lung perfusion disruption is critical.
  • Accurate bedside monitoring of lung perfusion is lacking, hindering ARDS diagnosis and treatment.
  • Electrical impedance tomography (EIT) can estimate regional lung perfusion using conductive indicators, but the standard indicator (hypertonic sodium chloride) has limited accessibility.

Purpose of the Study:

  • To investigate the comparability of sodium bicarbonate as an indicator for regional lung perfusion measurement using EIT, against the standard hypertonic sodium chloride.
  • To assess the agreement between sodium bicarbonate and hypertonic sodium chloride for EIT-derived lung perfusion in a swine model of lung injury.

Main Methods:

  • A swine model of lung injury was utilized with five pigs.
  • Regional lung perfusion was measured using EIT with both 12% sodium chloride and 8.4% sodium bicarbonate as indicators.
  • Perfusion was analyzed across different lung regions and experimental conditions (body position, PEEP).
  • Maximum slope analysis of indicator-based impedance signals was used to determine regional perfusion.

Main Results:

  • Estimates of regional lung perfusion using sodium bicarbonate showed strong agreement with hypertonic sodium chloride overall (mean bias 0%) and within lung quadrants.
  • The agreement between the two indicators remained consistent across various experimental conditions.
  • No significant change in the difference of regional lung perfusion estimates was observed across conditions.

Conclusions:

  • Sodium bicarbonate demonstrates comparable performance to hypertonic sodium chloride for estimating regional lung perfusion via EIT.
  • Sodium bicarbonate presents a potentially more accessible and practical indicator for bedside EIT-based lung perfusion monitoring in ARDS.
  • This finding supports the wider adoption of EIT for real-time lung perfusion assessment in clinical settings.