Practical Integration of Bedside Real-Time Lung Ultrasound and Electrical Impedance Tomography for Guiding Personalized Perioperative Lung Protective Ventilation in Cardiothoracic and Vascular Anesthesia.

Patients undergoing cardiothoracic and vascular surgery are at uniquely high risk for postoperative pulmonary complications due to the confluence of surgical trauma, one-lung ventilation, cardiopulmonary bypass, and sternotomy. This review evaluates the critical role of real-time bedside imaging-specifically lung ultrasound and electrical impedance tomography-in transitioning from empirical, fixed lung-protective ventilation strategies to dynamic, physiology-guided personalization. While conventional computed tomography established the pathophysiology of anesthesia-induced atelectasis, its utility for intraoperative guidance is limited. Lung ultrasound provides rapid, point-of-care morphological assessment for atelectasis, pleural effusion, and pneumothorax, guiding immediate interventions. Electrical impedance tomography offers continuous, radiation-free monitoring of regional ventilation distribution, enabling precise titration of positive end-expiratory pressure and recruitment maneuvers to balance lung recruitment against overdistension-a paramount concern during one-lung ventilation and post cardiopulmonary bypass. We argue that integrating these complementary modalities into a tiered monitoring protocol represents a prerequisite for advanced lung protection in this high-risk population. The future integration of artificial intelligence promises enhanced predictive analytics. We conclude by advocating for structured clinical protocols and multicenter trials to validate the efficacy and cost-effectiveness of this imaging-guided paradigm in improving respiratory outcomes for cardiothoracic surgical patients.