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

Rationale: Electrical impedance tomography (EIT) allows instantaneous and continuous visualization of regional ventilation and changes in end-expiratory lung volume at the bedside. There is particular interest in using EIT for monitoring in critically ill neonates and young children with respiratory failure. Previous studies have focused only on short-term monitoring in small populations. The feasibility and safety of prolonged monitoring with EIT in neonates and young children have not been demonstrated yet. Objectives: To evaluate the feasibility and safety of long-term EIT monitoring in a routine clinical setting and to describe changes in ventilation distribution and homogeneity over time and with positioning in a multicenter cohort of neonates and young children with respiratory failure. Methods: At four European University hospitals, we conducted an observational study (NCT02962505) on 200 patients with postmenstrual ages (PMA) between 25 weeks and 36 months, at risk for or suffering from respiratory failure. Continuous EIT data were obtained using a novel textile 32-electrode interface and recorded at 48 images/s for up to 72 hours. Clinicians were blinded to EIT images during the recording. EIT parameters and the effects of body position on ventilation distribution were analyzed offline. Results: The average duration of EIT measurements was 53 ± 20 hours. Skin contact impedance was sufficient to allow image reconstruction for valid ventilation analysis during a median of 92% (interquartile range, 77-98%) of examination time. EIT examinations were well tolerated, with minor skin irritations (temporary redness or imprint) occurring in 10% of patients and no moderate or severe adverse events. Higher ventilation amplitude was found in the dorsal and right lung areas when compared with the ventral and left regions, respectively. Prone positioning resulted in an increase in the ventilation-related EIT signal in the dorsal hemithorax, indicating increased ventilation of the dorsal lung areas. Lateral positioning led to a redistribution of ventilation toward the dependent lung in preterm infants and to the nondependent lung in patients with PMA > 37 weeks. Conclusions: EIT allows continuous long-term monitoring of regional lung function in neonates and young children for up to 72 hours with minimal adverse effects. Our study confirmed the presence of posture-dependent changes in ventilation distribution and their dependency on PMA in a large patient cohort. Clinical trial registered with www.clinicaltrials.gov (NCT02962505).

On the Implementation of Simultaneous Multi-Frequency Excitations and Measurements for Electrical Impedance Tomography.

The investigation of quickly-evolving flow patterns in high-pressure and high-temperature flow rigs requires the use of a high-speed and non-intrusive imaging technique. Electrical Impedance Tomography (EIT) allows reconstructing the admittivity distribution characterizing a flow from the knowledge of currents and voltages on its periphery. The need for images at high frame rates leads to the strategy of simultaneous multi-frequency voltage excitations and simultaneous current measurements, which are discriminated using fast Fourier transforms. The present study introduces the theory for a 16-electrode simultaneous EIT system, which is then built based on a field programmable gate array data acquisition system. An analysis of the propagation of uncertainties through the measurement process is investigated, and experimental results with fifteen simultaneous signals are presented. It is shown that the signals are successfully retrieved experimentally at a rate of 1953 frames per second. The associated signal-to-noise ratio varies from 59.6-69.1 dB, depending on the generated frequency. These preliminary results confirm the relevance and the feasibility of simultaneous multi-frequency excitations and measurements in EIT as a means to significantly increase the imaging rate.

A Simultaneous and Continuous Excitation Method for High-Speed Electrical Impedance Tomography with Reduced Transients and Noise Sensitivity.

This paper presents a concept for soft field tomographic scan of all the projections of electromagnetic waves emanating from an array of electrodes. Instead of the sequential excitation of all pairs of electrodes in the list of all projections, the new method present here consists of a single and continuous excitation. This excitation signal is the linear combination of the excitation signals in the projection set at different AC frequencies. The response to a given projection is discriminated by selecting the corresponding AC frequency component in the signal spectra of the digitally demodulated signals. The main advantage of this method is the suppression of transients after each projection, which is particularly problematic in electrical impedance tomography due to contact impedance phenomena and skin effect. The second benefit over the sequential scan method is the increased number of samples for each measurement for reduced noise sensitivity with digital demodulation. The third benefit is the increased temporal resolution in high-speed applications. The main drawback is the increased number of signal sources required (one per electrode). This paper focuses on electrical impedance tomography, based on earlier work by the authors. An experimental proof-of-concept using a simple 4-electrodes electrical impedance tomographic system is presented using simulations and laboratory data. The method presented here may be extended to other modalities (ultrasonic, microwave, optical, etc.).