Effect of routine suction on lung aeration in critically ill neonates and young infants measured with electrical impedance tomography.

Endotracheal suctioning is a widely used procedure to remove secretions from the airways of ventilated patients. Despite its prevalence, regional effects of this maneuver have seldom been studied. In this study, we explore its effects on regional lung aeration in neonates and young infants using electrical impedance tomography (EIT) as part of the large EU-funded multicenter observational study CRADL. 200 neonates and young infants in intensive care units were monitored with EIT for up to 72 h. EIT parameters were calculated to detect changes in ventilation distribution, ventilation inhomogeneity and ventilation quantity on a breath-by-breath level 5-10 min before and after suctioning. The intratidal change in aeration over time was investigated by means of regional expiratory time constants calculated from all respiratory cycles using an innovative procedure and visualized by 2D maps of the thoracic cross-section. 344 tracheal suctioning events from 51 patients could be analyzed. They showed no or very small changes of EIT parameters, with a dorsal shift of the center of ventilation by 0.5% of the chest diameter and a 7% decrease of tidal impedance variation after suctioning. Regional time constants did not change significantly. Routine suctioning led to EIT-detectable but merely small changes of the ventilation distribution in this study population. While still a measure requiring further study, the time constant maps may help clinicians interpret ventilation mechanics in specific cases.

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).

An Imaged Based Method for Universal Performance Evaluation of Electrical Impedance Tomography Systems.

This paper describes a simple and reproducible method for universal evaluation of the performance of electrical impedance tomography (EIT) systems using reconstructed images. To address the issues where common electrical parameters are not directly related to the quality of EIT images, based on objective full reference (FR) image quality assessment, the method provides a visually distinguishable hot colormap and two new FR metrics, the global and the more specific 'region of interest'. A passive 16 electrode EIT system using an application specific integrated circuit front-end was used to evaluate the proposed method. The measured results show, both visually and in terms of the proposed FR metrics, the impact on recorded EIT images with different design parameters and non-idealities. The paper also compares the image results of a passive electrode system with a matched 'single variable' active electrode system and demonstrates the merit of an active electrode system for noise interference. A figure of merit based on the FR metrics is proposed.

Analysis and compensation for errors in electrical impedance tomography images and ventilation-related measures due to serial data collection.

Electrical impedance tomography (EIT) is increasingly being used as a bedside tool for monitoring regional lung ventilation. However, most clinical systems use serial data collection which, if uncorrected, results in image distortion, particularly at high breathing rates. The objective of this study was to determine the extent to which this affects derived parameters. Raw EIT data were acquired with the GOE-MF II EIT device (CareFusion, Höchberg, Germany) at a scan rate of 13 images/s during both spontaneous breathing and mechanical ventilation. Boundary data for periods of undisturbed tidal breathing were corrected for serial data collection errors using a Fourier based algorithm. Images were reconstructed for both the corrected and original data using the GREIT algorithm, and parameters describing the filling characteristics of the right and left lung derived on a breath by breath basis. Values from the original and corrected data were compared using paired t-tests. Of the 33 data sets, 23 showed significant differences in filling index for at least one region, 11 had significant differences in calculated tidal impedance change and 12 had significantly different filling fractions (p = 0.05). We conclude that serial collection errors should be corrected before image reconstruction to avoid clinically misleading results.

The effect of serial data collection on the accuracy of electrical impedance tomography images.

There has been a surge of interest in using electrical impedance tomography (EIT) for monitoring regional lung ventilation, however, EIT is an ill-conditioned problem, and errors/noise in the boundary voltages can have an undesirable effect on the quality of the final image. Most EIT systems in clinical usage use serial data collection hence data used to create a single image will have been collected at different times. This paper presents a study of the resulting image distortion, and proposes a method for correcting this lag in situations where the frame rate is insufficient to prevent significant image degradation. Significant correlation between the standard deviation of the time dependent reciprocity error and time delay dLe between the reciprocal electrode combinations was found for both adult and neonate data. This was reduced when the data was corrected for dLe. Original and corrected data was reconstructed with the GREIT algorithm and visible differences were found for the neonate data. Ideally EIT systems should be run at a frame rate of at least 50 times the frequency of the dominant and interesting physiological signals. Where this is not practical, the intra-frame system timings should be determined and lag corrected for.

Spatial resolution improvement of 3D EIT images by the shrinking sLORETA-FOCUSS algorithm.

This paper describes the use of the shrinking sLORETA-FOCUSS algorithm to improve the spatial resolution of three-dimensional (3D) EIT images. Conventional EIT yields inaccurate, low spatial resolution images, due to noise, the low sensitivity of boundary voltages to inner conductivity perturbations and a limited number of boundary voltage measurements. The focal underdetermined system solver (FOCUSS) algorithm produces a localized energy solution based on the weighted minimum-norm least-squares (MNLS) solution. It was successfully applied for the spatial resolution improvement of EIT images of simulated and tank data for a 2D homogeneous circular disc. However, due to the fact that a 3D mesh system contains many more elements, much more memory is required to store the weighting matrix. In order to extend the work to 3D, the shrinking-FOCUSS method is utilized to shrink the solution space as well as the weighting matrix in each iteration step. The solution of the standardized low resolution electromagnetic tomography algorithm (sLORETA) is adopted as the initial estimate of the shrinking-FOCUSS. The effectiveness is verified by implementing the new algorithm on tank data for a three-dimensional homogeneous sphere.

The spatial resolution improvement of EIT images by GVSPM-FOCUSS algorithm.

The focal underdetermined system solver (FOCUSS) algorithm is a recursive algorithm to find the localized energy solution. It is an initialization-dependent algorithm. The generalized vector sample pattern matching (GVSPM) method has been applied to solve the inverse problem of electrical impedance tomography (EIT) and obtain smooth reconstructed images. By combining the GVSPM solution as the initial estimation of the FOCUSS algorithm, an idea termed the GVSPM-FOCUSS method is presented in this paper to improve the spatial resolution and precision of localization for EIT images. The comparisons are carried out between the EIT images reconstructed with the GVSPM-FOCUSS method and the GVSPM method alone. The effectiveness is verified by simulated and tank data for a model of a two-dimensional homogeneous circular disk.

The application of the generalized vector sample pattern matching method for EIT image reconstruction.

This paper presents a new application of a generalized vector sample pattern matching (GVSPM) method for image reconstruction of conductivity changes in electrical impedance tomography. GVSPM is an iterative method for linear inverse problems. The key concept of the GVSPM is that the objective function is defined in terms of an angular component between the inner product of the known vector and solution of a system of equations. Comparisons are presented between images of simulated and experimental data, reconstructed using truncated singular value decomposition and GVSPM. In both cases, a normalized sensitivity matrix is constructed using the finite volume method to solve the forward problem.