Electrical impedance tomography in perioperative medicine: careful respiratory monitoring for tailored interventions

Elena Spinelli, Tommaso Mauri, Alberto Fogagnolo, Gaetano Scaramuzzo, Annalisa Rundo, Domenico Luca Grieco, Giacomo Grasselli, Carlo Alberto Volta, Savino Spadaro, Elena Spinelli, Tommaso Mauri, Alberto Fogagnolo, Gaetano Scaramuzzo, Annalisa Rundo, Domenico Luca Grieco, Giacomo Grasselli, Carlo Alberto Volta, Savino Spadaro

Abstract

Background: Electrical impedance tomography (EIT) is a non-invasive radiation-free monitoring technique that provides images based on tissue electrical conductivity of the chest. Several investigations applied EIT in the context of perioperative medicine, which is not confined to the intraoperative period but begins with the preoperative assessment and extends to postoperative follow-up.

Main body: EIT could provide careful respiratory monitoring in the preoperative assessment to improve preparation for surgery, during anaesthesia to guide optimal ventilation strategies and to monitor the hemodynamic status and in the postoperative period for early detection of respiratory complications. Moreover, EIT could further enhance care of patients undergoing perioperative diagnostic procedures. This narrative review summarizes the latest evidence on the application of this technique to the surgical patient, focusing also on possible future perspectives.

Conclusions: EIT is a promising technique for the perioperative assessment of surgical patients, providing tailored adaptive respiratory and haemodynamic monitoring. Further studies are needed to address the current technological limitations, confirm the findings and evaluate which patients can benefit more from this technology.

Keywords: Electrical impedance tomography; Hemodynamic monitoring; Non-operating room anaesthesia; Perioperative medicine.

Conflict of interest statement

GG received a payment for lectures from Getinge, Draeger Medical, Pfizer, Fisher & Paykel; received a payment for travel/accommodation/congress registration support from Getinge and Biotest. TM receiving speaking fees from Draeger outside of the present work. SS received a payment for travel/accommodation/congress registration support from Getinge. The other authors declare no conflicts of interests.

Figures

Fig. 1
Fig. 1
End expiratory lung impedance change during anesthesia induction. Evaluation of End-Expiratory Lung Impedance (EELI, continuous blue line) and End Inspiratory Lung Impedance (EILI, blue dots, non-continuous blue line) during different moments of general anesthesia induction in a 65 years old patient undergoing laparoscopic cholecystectomy. Note decrease of TV and EELV during anesthesia induction and increase in EELV during mask ventilation with PEEP. Finally, stable ventilation and EELV were reached after intubation and start of control mechanical ventilation
Fig. 2
Fig. 2
Tidal volume distribution during spontaneous breathing (a) and mechanical ventilation (b). Tidal image (top) and relative stretch distribution (bottom) during spontaneous breathing (a) and after intubation and start of controlled mechanical ventilation (b) in the same patient undergoing general anesthesia. During mechanical ventilation, tidal volume is redistributed toward the ventral lung; moreover, hypoventilated areas increase, as shown by the relative stretch histogram (lower values indicate smaller regional tidal volume)
Fig. 3
Fig. 3
Electrical impedance tomography (EIT) image acquired during a non-bronchoscopic bronchoalveolar lavage (blindBAL) performed in the dorsal lung. (Grieco et al., Intensive Care Med (2016) 42: 1088)

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