Electrical Impedance Tomography–Guided Airway Clearance in Elderly Patients With Severe Pneumonia: A Prospective Study

IF 2.3 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal Pub Date : 2025-07-13 DOI:10.1111/crj.70110

Jiaping Zhao, Wenchao Mao, Yi Zhang, Saichan Xu, Fei Qian, Liang Wu, Shijin Gong, Weihang Hu, Changyun Zhao

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引用次数: 0

Abstract

Background

Elderly patients are prone to secretion retention and exacerbated lung infections due to weakened respiratory muscle strength and reduced ability to cough and expectorate. Airway clearance techniques (ACTs) can help to clear airway secretions, but objective bedside assessment of secretion clearance efficacy is lacking. Electrical impedance tomography (EIT) can dynamically monitor lung ventilation and provide a basis for clinical decision-making.

Methods

This study was a prospective randomized controlled trial that included 50 elderly patients with severe pneumonia, who were randomized into EIT and non-EIT groups. The EIT group received personalized ACTs guided by real-time EIT imaging with dynamic adjustment of posture, percussion intensity, and active circulatory breathing technique (ACBT) frequency, whereas the non-EIT group received fixed-schedule ACTs (postural drainage every 2 h + percussion/vibration twice daily) without EIT feedback. The main observation indices included Clinical Pulmonary Infection Score (CPIS), respiratory mechanics indices, blood gas analysis indices, and extubation success rate.

Results

The EIT group showed significantly lower CPIS scores (p = 0.0137 on Day 7), higher dynamic compliance (p = 0.0193), lower airway resistance (p = 0.0039), lower peak airway pressure (p = 0.0288), and higher oxygenation index (p = 0.0143 on Day 5 and p = 0.0005 on Day 7) than the non-EIT group. The extubation success rate was significantly higher in the EIT group (88% vs. 56%, p = 0.0255). Additionally, the EIT group demonstrated progressive improvements in ventilation in specific regions (D7 vs. D1: p = 0.0004 for region of interest [ROI]3; p = 0.0059 for ROI4) and a significant decrease in the global inhomogeneity index at D7 (D7 vs. D1: p = 0.0025).

Conclusion

EIT-guided ACT is safe and enhances treatment efficacy by significantly improving respiratory function and extubation success rate in elderly patients with severe pneumonia.

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电阻抗断层扫描引导老年重症肺炎患者气道清除率：一项前瞻性研究

背景老年患者由于呼吸肌力减弱，咳嗽和咳痰能力下降，容易出现分泌物潴留，加重肺部感染。气道清除技术（act）有助于清除气道分泌物，但缺乏对分泌物清除效果的客观床边评估。电阻抗断层扫描（EIT）可以动态监测肺通气情况，为临床决策提供依据。方法采用前瞻性随机对照试验，将50例老年重症肺炎患者随机分为EIT组和非EIT组。EIT组接受实时EIT成像指导下的个性化act，动态调整体位、打击强度和主动循环呼吸技术（ACBT）频率，而非EIT组接受固定时间act（每2小时体位引流+每天两次打击/振动），无EIT反馈。主要观察指标包括临床肺部感染评分（CPIS）、呼吸力学指标、血气分析指标、拔管成功率。结果EIT组CPIS评分（第7天p = 0.0137）、动态顺应性（p = 0.0193）、气道阻力（p = 0.0039）、气道压力峰（p = 0.0288）、氧合指数（第5天p = 0.0143、第7天p = 0.0005）显著低于非EIT组。EIT组拔管成功率明显高于对照组（88%比56%，p = 0.0255）。此外，EIT组在特定区域的通气表现出进行性改善(D7 vs. D1：感兴趣区域[ROI]3 p = 0.0004；ROI4的p = 0.0059)， D7时全球不均匀性指数显著下降（D7 vs. D1: p = 0.0025）。结论eit引导ACT治疗老年重症肺炎患者呼吸功能和拔管成功率明显提高，安全可靠，可提高治疗效果。

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来源期刊

Clinical Respiratory Journal 医学-呼吸系统

CiteScore

3.70

自引率

0.00%

发文量

104

审稿时长

>12 weeks

期刊介绍： Overview Effective with the 2016 volume, this journal will be published in an online-only format. Aims and Scope The Clinical Respiratory Journal (CRJ) provides a forum for clinical research in all areas of respiratory medicine from clinical lung disease to basic research relevant to the clinic. We publish original research, review articles, case studies, editorials and book reviews in all areas of clinical lung disease including: Asthma Allergy COPD Non-invasive ventilation Sleep related breathing disorders Interstitial lung diseases Lung cancer Clinical genetics Rhinitis Airway and lung infection Epidemiology Pediatrics CRJ provides a fast-track service for selected Phase II and Phase III trial studies. Keywords Clinical Respiratory Journal, respiratory, pulmonary, medicine, clinical, lung disease, Abstracting and Indexing Information Academic Search (EBSCO Publishing) Academic Search Alumni Edition (EBSCO Publishing) Embase (Elsevier) Health & Medical Collection (ProQuest) Health Research Premium Collection (ProQuest) HEED: Health Economic Evaluations Database (Wiley-Blackwell) Hospital Premium Collection (ProQuest) Journal Citation Reports/Science Edition (Clarivate Analytics) MEDLINE/PubMed (NLM) ProQuest Central (ProQuest) Science Citation Index Expanded (Clarivate Analytics) SCOPUS (Elsevier)