[Safety and efficacy of electrical impedance tomography-guided airway clearance in mechanically ventilated patients].

Objective

To evaluate the safety and efficacy of an electrical impedance tomography (EIT)-guided airway clearance protocol in mechanically ventilated patients.

Methods

A total of 62 mechanically ventilated patients admitted to the intensive care units of two tertiary Grade A hospitals in Beijing between January 2024 and April 2025 were enrolled. Patients were allocated into two groups: the intervention group (n=31) received EIT-guided airway clearance, while the control group (n=31) received conventional airway clearance based on admission chest CT findings. Airway clearance efficacy and safety were compared between the two groups. Statistical analysis was performed using SPSS 26.0.

Results

In the intervention group, the global inhomogeneity index (GI) improved significantly from day 1 to day 7 (0.45±0.14 vs. 0.36±0.05, t=2.060, P<0.05). On day 1, the left-right ventilation distribution difference in the ventral region was significantly reduced at 10 minutes and 30 minutes post-clearance compared with pre-clearance (9.19%±8.29%, 8.41%±7.92% vs. 14.03%±8.35%). The left-right ventilation distribution difference in the dorsal region was significantly lower at 1 hour post-clearance compared with pre-clearance (7.09%±5.50% vs. 10.32%±7.24%). At 30 minutes and 1 hour post-clearance, the center of ventilation (49.45±3.16, 49.00±3.65 vs. 45.80±5.91) and the GI (0.39±0.05, 0.39±0.07 vs. 0.45±0.14) were significantly improved compared with pre-clearance (all P<0.05). On day 7, the left-right ventral ventilation distribution difference was significantly reduced at 10 minutes, 30 minutes, and 1 hour post-clearance compared with pre-clearance (8.32%±7.11%, 6.48%±6.94%, 5.90%±6.05% vs. 12.32%±9.66%). The area of high-density opacities on chest CT was reduced in both groups after two weeks of treatment, with a more pronounced reduction in the intervention group (P<0.05). The intervention group had significantly less daily sputum output on day 7 than the control group (55.48±14.28 ml vs. 80.00±22.77 ml), and demonstrated greater improvement in sputum viscosity distribution on days 5 and 7 (P<0.05). After treatment, the intervention group showed a greater increase in the oxygenation index (286.88±81.97 mmHg vs. 223.00±73.82 mmHg) and a greater decrease in leukocyte count [(11.01±5.48)×109/L vs. (13.88±4.95)×109/L] than the control group (both P<0.05).The total number of airway clearance sessions (12.23±2.80 vs. 14.00±0.00) and the duration of mechanical ventilation (12.55±5.18 days vs. 16.29±8.75 days) were significantly lower in the intervention group than in the control group (both P<0.05). No adverse events, including catheter displacement, dislodgement or massive haemoptysis, occurred in either group during the procedure.

Conclusion

The EIT-guided airway clearance protocol is safe and effective in mechanically ventilated patients, providing a scientific basis for the selection and efficacy evaluation of airway clearance strategies in this setting.