title: Electrical impedance tomography as possible guidance for individual positioning of patients with multiple lung injury.
abstract: BACKGROUND
  Electrical Impedance Tomography (EIT) is a tomographic, radiation-free technique based on the injection of a harmless alternating current.
  
  
  OBJECTIVE
  As electrical impedance strictly correlates with the variation of air content, EIT delivers highly dynamic information about global and regional ventilation. We want to demonstrate the potential of EIT individualizing ventilation by positioning.
  
  
  METHODS
  Gravity-dependent EIT findings were analyzed retrospectively in a critically ill mechanically ventilated pediatric patient with cystic fibrosis and coincident lung diseases. To further evaluate gravity-dependent changes in ventilation, six adult healthy and spontaneously breathing volunteers were investigated during simultaneous detection of EIT, breathing patterns, tidal volume (VT) and breathing frequency (BF).
  
  
  RESULTS
  EIT findings in healthy lungs in five positions showed gravity-dependent effects of ventilation with overall ventilation of predominantly the right lung (except during left-side positioning) and with the ventral lung in supine, prone and upright position. These EIT-derived observations are in line with pathophysiological mechanisms and earlier EIT studies. Unexpectedly, the patient with cystic fibrosis and lobectomy of the right upper and middle lobe one year earlier, showed improvement of global and regional ventilation in the right position despite reduced lung volume and overinflation of this side. This resulted in individualized positioning and improvement of ventilation.
  
  
  CONCLUSIONS
  Although therapeutic recommendations are available for gravitational influences of lung ventilation, they can be contradictory depending on the underlying lung disease. EIT has the potential to guide therapists in the positioning of patients according to their individual condition and disease, especially in case of multiple lung injury.
authors.affiliation: Department of Pediatrics, Division Pediatric Pulmonology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Lehmann
authors.affiliation: Philips Chair for Medical Information Technology, RWTH Aachen, Aachen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Leonhardt
authors.affiliation: Philips Chair for Medical Information Technology, RWTH Aachen, Aachen, Germany.
authors.forename: Chuong
authors.initials: C
authors.lastname: Ngo
authors.affiliation: Philips Chair for Medical Information Technology, RWTH Aachen, Aachen, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Bergmann
authors.affiliation: Department of Radiology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Schrading
authors.affiliation: Department of Pediatrics, Division of Neonatology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Heimann
authors.affiliation: Department of Pediatrics, Division Pediatric Pulmonology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Wagner
authors.affiliation: Department of Pediatrics, Division Pediatric Pulmonology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Tenbrock
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D017097:Electric Impedance; D005260:Female; D006801:Humans; D055370:Lung Injury / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D056888:Patient Positioning / Q000592:standards*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
keywords:  gravity; EIT; cystic fibrosis; infiltration; lung; overinflation