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Monitoring Lung Function with Electrical Impedance Tomography in the Intensive Care Unit
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Ventilatory Management Using Electrical Impedance Tomography in an Obese Patient Undergoing Robot-Assisted
Ayumu Matsumoto1, Satoshi Kamiya1, Soshi Narasaki1
1Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima JAPAN.
The Journal of Medical Investigation : JMI
|November 3, 2025
Summary
Electrical impedance tomography (EIT) guided mechanical ventilation in obese patients undergoing rectal resection required higher positive end-expiratory pressure (PEEP) during pneumoperitoneum to prevent lung collapse, differing from standard guidelines.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Medical Engineering
Background:
- Obesity presents challenges in mechanical ventilation during robotic-assisted laparoscopic surgery.
- Intraoperative lung management requires careful titration of ventilator settings, particularly positive end-expiratory pressure (PEEP).
- Electrical impedance tomography (EIT) offers a noninvasive method for assessing lung aeration and ventilation distribution.
Purpose of the Study:
- To evaluate the utility of EIT in guiding ventilatory management, specifically PEEP titration, in an obese patient undergoing robot-assisted laparoscopic rectal resection.
- To determine optimal PEEP levels during different surgical phases, including supine positioning, pneumoperitoneum, and head-lowering maneuvers.
Main Methods:
- Case study involving a male patient with obesity (BMI: 31) undergoing robot-assisted laparoscopic rectal resection under general anesthesia.
- Application of EIT to monitor lung impedance changes and guide PEEP adjustments.
- Comparison of PEEP requirements across different surgical positions and insufflation states.
Main Results:
- A PEEP of 10-12 cmH2O was sufficient for supine positioning with balanced lung impedance changes.
- A higher PEEP of 20 cmH2O was necessary during pneumoperitoneum and head lowering to maintain lung aeration and prevent collapse.
- Oxygenation was maintained throughout the procedure without major complications.
Conclusions:
- EIT can provide real-time, bedside assessment of lung conditions during surgery.
- Tailoring PEEP based on EIT findings, especially in obese patients with altered surgical positioning, may be crucial for preventing intraoperative lung injury.
- This approach could refine current intraoperative ventilator management strategies.
