Monitoring of Regional Ventilation Distribution Using Electrical Impedance Tomography in Pediatric Patients With Chest Physiotherapy-A Feasibility Study

Abstract

Background: Current evidence remains unclear whether pediatric patients with acute or chronic lung diseases benefit from chest physiotherapy (CPT) during spontaneous breathing. Electrical impedance tomography (EIT) offers the opportunity to assess treatment effects of CPT on regional ventilation distribution.

Methods: We conducted a prospective feasibility study between 10/2023 and 05/2024. Pediatric patients with need for active or passive CPT were screened. EIT measurements were performed immediately before CPT intervention (T1), and within 30 min after CPT intervention (T2).

Results: Overall, 25 patients were enrolled, with two patients enrolled twice at different admissions, resulting in a total of 54 EIT-measurements. The mean horizontal center of ventilation (CoVx) and the mean vertical CoVy were equally distributed at T1 and T2, without any difference seen when subdividing for mode of CPT. The mean global inhomogeneity index (GI) decreased from 0.38 to 0.36 (∆GI: -6%, p = 0.939) in the overall cohort, with a significant decrease between T1 and T2 in patients with active (∆GI: -10%, p = 0.015), but not in patients with passive CPT (∆GI: +6%, p = 0.199). In patients with a localized pulmonary finding in the radiological assessment (n = 10) we observed an increase in the ventilated lung area (EIT-pixel) of the affected lung side after CPT (T1: 141 vs. T2: 176; p = 0.128).

Conclusion: EIT seems feasible to monitor changes in regional ventilation distribution after CPT in pediatric patients. Patients with localized pulmonary radiological findings and patients after active CPT appear to benefit most from CPT, whereas there is a subset of individuals with no response to CPT.

Keywords: chest physiotherapy; children; electrical impedance tomography (EIT); regional ventilation.

FIGURE 1

Flow‐chart of patients’ inclusion. [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

(A–C): (A) The distribution of the mean CoV (X + Y) is illustrated in panel A for respective patients before (T1) and after (T2) active CPT. (B) The regional ventilation distribution in four regions of interest (ROI, ventral‐dorsal) is illustrated for all patients at T1 and T2. (C) The Global Inhomogeneity Index (GI) is illustrated for the according subgroups (active vs. passive CPT) at T1 and T2. [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

(A–C): (A) The Global Inhomogeneity Index (GI) is illustrated for the according subgroups (radiological pulmonary finding vs. no finding) at T1 and T2. (B) The regional ventilated lung area (EIT‐pixel) is illustrated for the affected lung side (radiological pulmonary finding) (B) and the non‐affected lung side (C). [Color figure can be viewed at wileyonlinelibrary.com]