Mechanical ventilation is lifesaving therapy, and the quality of the treatment can impact patient outcomes for better or worse. But no two patients are the same, so there is no standard setting for providing top-quality mechanical ventilation throughout the course of treatment. On the contrary, it makes a difference to continuously work with optimization of the ventilation strategy for each patient. Enter electrical impedance tomography (EIT): A technology that offers unique, real-time insight into the mechanical ventilation of patients. That means less guesswork and more precision in mechanical ventilation. Read on to get an overview of the benefits to you and your patients.
Electrical impedance tomography (EIT) (åbner i ny fane) is a technology that uses electrical signals to measure resistance and generate images with the collected data. In a medical setting, the technology is applied by placing electrodes on the patient’s skin that emit a low-intensity current. It is a technology that has several benefits (åbner i ny fane) compared to other imaging technologies: It is non-invasive, radiation-free, and generates real-time images. This also allows the technology to be used bedside.
EIT can be applied in different clinical settings. What we are diving into is the use of EIT technology for pulmonary ventilation monitoring (åbner i ny fane). The solutions created for this purpose use electrodes which are placed around the patient’s chest. They inject low-intensity current that detects the difference in resistance of tissue, air and fluids. The signals are then used to generate an image of a cross-section of the lungs, which is displayed on a monitor. The image is dynamic and enables real-time monitoring of the distribution of air in the patient’s lungs.
Even though ventilators are becoming increasingly intelligent, there is still information that cannot be obtained by the ventilator alone. A monitor built with EIT technology can provide additional and enhanced insight into the mechanical ventilation of patients.
A common ventilation challenge is finding the right PEEP (positive end expiratory pressure) setting for each patient. The right PEEP setting can be defined as the one that avoids both overdistention and collapse of the lungs. Both scenarios are harmful to the lungs, and overdistention has even been shown to increase mortality (åbner i ny fane) in ARDS (acute respiratory distress syndrome).
Another challenge is identifying asynchronies between patient and ventilator such as double trigger and reverse trigger (åbner i ny fane). These types of asynchronies occur when two consecutive breaths follow each other too quickly, and the patient is not allowed enough expiratory time. Double trigger occurs when the breath is triggered by the patient, and reverse trigger occurs when the breath is triggered by the ventilator. Asynchrony between patient and ventilator worsens outcomes: Studies have shown (åbner i ny fane) that asynchronies can lead to higher mortality rates both in the ICU and hospital, and extend the duration of the mechanical ventilation.
EIT technology can reliably assess ventilation distribution (åbner i ny fane) during mechanical ventilation. This helps identify imbalances in ventilation and areas with collapse and overdistention, which may cause VILI (ventilator-induced lung injury). In fact, EIT is the only bedside monitoring technology (åbner i ny fane) that enables identification of relative overdistention and collapse at the same time. A study (åbner i ny fane) also suggests that EIT may provide a better understanding of regional lung perfusion under different lung conditions. These insights into air distribution and asymmetries can be used to determine the positioning of the patient. Positioning strategy can significantly impact lung mechanics and decrease collapse and overdistention (åbner i ny fane).
The real-time view of air distribution in the patient’s lungs allows for making timely adjustments tailored to the individual patient. In a study (åbner i ny fane) with obese patients with ARDS, an individualized protocol for ventilator settings improved survival. Another study (åbner i ny fane) with a similar group of patients found that individualized optimization of ventilation reduced the duration of the mechanical ventilation, and the length of the ICU stay.
Nicolai Hess Pedersen, Area Manager at Medidyne says about the technology: “Electrical impedance tomography not only provides enhanced insight, but a whole new level of insight into mechanical ventilation: With an EIT monitor clinicians can immediately see the impact of their interventions and adjust treatment accordingly. Timely and tailored adjustments help create better outcomes and increase comfort for the patient”.
Read our article about the benefits of individualized ventilation.
At Medidyne we distribute the ENLIGHT 2100 across the Nordics. It is an EIT ventilation monitor developed by Timpel Medical. ENLIGHT 2100 has a unique set of features that provide valuable insight into ventilation of both neonatal patients and adults. In addition, the interface is user-friendly and presents data in a way that is easy to understand.
Among other things, ENLIGHT 2100 has a PEEP titration tool. It measures compliance, overdistention, and collapse in a PEEP trial. This information helps you set the right PEEP level for the individual patient. The monitor also enables you to identify double trigger and reverse trigger. It measures and visualizes the two types of asynchronies, so treatment can be adjusted accordingly. Furthermore, it is possible to measure perfusion with the monitor’s V/Q tool. This helps you identify imbalances in perfusion and understand the underlying cause of hypoxemia.
At the ICU at Hvidovre University Hospital in Denmark, the ENLIGHT 2100 is used in respiratory care. Ronni Plovsing, MD, PhD, and Associate Professor at Hvidovre ICU, says the following about the monitor:
“Timpel’s ENLIGHT 2100 is a powerful, non-invasive tool in bedside respiratory care. It supports clinical decision-making with real-time breath-to-breath monitoring of ventilation distribution and furthermore visualizes the effects of different pressures on lung tissue. This enables us to fine-tune treatment to the individual patient’s needs and thereby maximize lung-protection. Another pivotal step towards personalized respiratory care in critically ill patients”.
Ronni Plovsing, MD, PhD, and Associate Professor at Hvidovre ICU
Electrical impedance tomography can help optimize mechanical ventilation treatment for the benefit of both patients and clinicians.
With EIT, patients get monitoring that is non-invasive, radiation-free and can be used bedside. That enhances comfort. Clinicians can use the insight from the monitor to provide personalized, lung-protective treatment and determine the best positioning of the patient. As the monitor provides live data, it enables continuous monitoring, adjustment and optimization of treatment. This helps minimize patient effort and maximize compliance throughout the course of treatment. With optimized ventilation settings, the number of ventilator-associated complications may be reduced. This may in turn lead to fewer days with mechanical ventilation and hence a better outcome for the patient.
A better patient outcome is the overall goal in healthcare. In addition to improving care, EIT monitoring helps clinicians by being simple to use and cost-effective. The belts measuring the impedance can be put on patients as part of the care routine, and then one monitor can easily and quickly be moved from one patient to another. EIT monitoring is also cost-effective in comparison to CT or MRI scans. Plus, it can potentially reduce healthcare costs through optimized treatment, as the patient may spend less time at the ICU.
Electrical impedance tomography (EIT) monitoring provides actionable insights that are easy to understand and enable timely adjustments to the ventilation strategy. You get real-time monitoring of lung-function and ventilation distribution breath by breath. You get non-invasive and safe monitoring for neonatal patients as well as adults. You get insight that helps you confirm ventilator settings and helps you detect ventilator-related issues. EIT ultimately helps you perform lung-protective ventilation in the most optimal way for each patient.
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Area Manager
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