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Clinical Investigations in Critical Care |

Electrical Impedance Tomography in the Assessment of Extravascular Lung Water in Noncardiogenic Acute Respiratory Failure*

Peter W. A. Kunst, MD; Anton Vonk Noordegraaf, MD; Esther Raaijmakers, MSC; Jan Bakker, MD, PhD; A. B. Johan Groeneveld, MD, PhD; Piet E. Postmus, MD, PhD, FCCP; Peter M. J. M. de Vries, MD, PhD
Author and Funding Information

*From the Departments of Pulmonary Medicine (Drs. Kunst, Noordegraaf, Postmus, and de Vries), Medical Physics and Informatics (Ms. Raaijmakers), and Intensive Care Medicine (Dr. Groeneveld), Institute for Cardiovascular Research, Academic Hospital “Vrije Universiteit,” Amsterdam; and Department of Intensive Care Medicine (Dr. Bakker), Hospital Centre Apeldoorn, Apeldoorn, The Netherlands.

Correspondence to: Peter W. A. Kunst, MD, Academic Hospital “Vrije Universiteit,” Department of Pulmonary Medicine, 1007 MB Amsterdam, The Netherlands



Chest. 1999;116(6):1695-1702. doi:10.1378/chest.116.6.1695
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Study objectives: To establish the value of electrical impedance tomography (EIT) in assessing pulmonary edema in noncardiogenic acute respiratory failure (ARF), as compared to the thermal dye double indicator dilution technique (TDD).

Design: Prospective clinical study.

Setting: ICU of a general hospital.

Patients: Fourteen ARF patients.

Interventions: In order to use the TDD to determine the amount of extravascular lung water (EVLW), a fiberoptic catheter was placed in the femoral artery.

Measurements and main results: Fourteen consecutive ARF patients receiving mechanical ventilation were measured by EIT and TDD. EIT visualizes the impedance changes caused by the ventilation in two-dimensional image planes. An impedance ratio (IR) of the ventilation-induced impedance changes of a posterior and an anterior part of the lungs was used to indicate the amount of EVLW. For the 29 measurements in 14 patients, a significant correlation between EIT and TDD (r = 0.85; p < 0.001) was found. The EIT reproducibility was good. The diagnostic value of the method was tested by receiver operator characteristic analysis, with 10 mL/kg of EVLW considered as the upper limit of normal. At a cutoff level of the IR of 0.64, the IR had a sensitivity of 93%, a specificity of 87%, and a positive predictive value of 87% for a supranormal amount of EVLW. Follow-up measurements were performed in 11 patients. A significant correlation was found between the changes in EVLW measured with EIT and TDD (r = 0.85; p < 0.005).

Conclusion: We conclude that EIT is a noninvasive technique for reasonably estimating the amount of EVLW in noncardiogenic ARF.

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