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      Absolute Electrical Impedance Tomography (aEIT) Guided Ventilation Therapy in Critical Care Patients: Simulations and Future Trends

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          Abstract

          Thoracic electrical impedance tomography (EIT) is a noninvasive, radiation-free monitoring technique whose aim is to reconstruct a cross-sectional image of the internal spatial distribution of conductivity from electrical measurements made by injecting small alternating currents via an electrode array placed on the surface of the thorax. The purpose of this paper is to discuss the fundamentals of EIT and demonstrate the principles of mechanical ventilation, lung recruitment, and EIT imaging on a comprehensive physiological model, which combines a model of respiratory mechanics, a model of the human lung absolute resistivity as a function of air content, and a 2-D finite-element mesh of the thorax to simulate EIT image reconstruction during mechanical ventilation. The overall model gives a good understanding of respiratory physiology and EIT monitoring techniques in mechanically ventilated patients. The model proposed here was able to reproduce consistent images of ventilation distribution in simulated acutely injured and collapsed lung conditions. A new advisory system architecture integrating a previously developed data-driven physiological model for continuous and noninvasive predictions of blood gas parameters with the regional lung function data/information generated from absolute EIT (aEIT) is proposed for monitoring and ventilator therapy management of critical care patients.

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          Most cited references24

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          Imbalances in regional lung ventilation: a validation study on electrical impedance tomography.

          Imbalances in regional lung ventilation, with gravity-dependent collapse and overdistention of nondependent zones, are likely associated to ventilator-induced lung injury. Electric impedance tomography is a new imaging technique that is potentially capable of monitoring those imbalances. The aim of this study was to validate electrical impedance tomography measurements of ventilation distribution, by comparison with dynamic computerized tomography in a heterogeneous population of critically ill patients under mechanical ventilation. Multiple scans with both devices were collected during slow-inflation breaths. Six repeated breaths were monitored by impedance tomography, showing acceptable reproducibility. We observed acceptable agreement between both technologies in detecting right-left ventilation imbalances (bias = 0% and limits of agreement = -10 to +10%). Relative distribution of ventilation into regions or layers representing one-fourth of the thoracic section could also be assessed with good precision. Depending on electrode positioning, impedance tomography slightly overestimated ventilation imbalances along gravitational axis. Ventilation was gravitationally dependent in all patients, with some transient blockages in dependent regions synchronously detected by both scanning techniques. Among variables derived from computerized tomography, changes in absolute air content best explained the integral of impedance changes inside regions of interest (r(2) > or = 0.92). Impedance tomography can reliably assess ventilation distribution during mechanical ventilation.
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            Uses and abuses of EIDORS: an extensible software base for EIT.

            EIDORS is an open source software suite for image reconstruction in electrical impedance tomography and diffuse optical tomography, designed to facilitate collaboration, testing and new research in these fields. This paper describes recent work to redesign the software structure in order to simplify its use and provide a uniform interface, permitting easier modification and customization. We describe the key features of this software, followed by examples of its use. One general issue with inverse problem software is the difficulty of correctly implementing algorithms and the consequent ease with which subtle numerical bugs can be inadvertently introduced. EIDORS helps with this issue, by allowing sharing and reuse of well-documented and debugged software. On the other hand, since EIDORS is designed to facilitate use by non-specialists, its use may inadvertently result in such numerical errors. In order to address this issue, we develop a list of ways in which such errors with inverse problems (which we refer to as 'cheats') may occur. Our hope is that such an overview may assist authors of software to avoid such implementation issues.
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              Lung injury caused by mechanical ventilation.

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                Author and article information

                Contributors
                Journal
                IEEE Trans Inf Technol Biomed
                IEEE Trans Inf Technol Biomed
                0047700
                ITIBFX
                TITB
                Ieee Transactions on Information Technology in Biomedicine
                IEEE
                1089-7771
                1558-0032
                May 2010
                10 November 2009
                : 14
                : 3
                : 641-649
                Affiliations
                [1 ] departmentDepartment of Automatic Control and Systems Engineering, institutionUniversity of Sheffield; Sheffield S3 7GG U.K.
                [2 ] departmentDepartment of Medical Physics, institutionUniversity of Sheffield; Sheffield S10 2JF U.K.
                [3 ] departmentDepartment of Critical Care and Anaesthesia, departmentNorthern General Hospital; Sheffield S5 7AU U.K.
                [4 ] institutionUniversity of Sheffield; SheffieldS3 7GG U.K.
                Article
                10.1109/TITB.2009.2036010
                7176469
                19906599
                ea920fe4-ac45-43c6-8aa5-ee632d5814c3
                Copyright @ 2009

                This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/

                History
                : 13 May 2009
                : 11 September 2009
                : 03 June 2010
                Page count
                Figures: 15, Tables: 2, Equations: 53, References: 29, Pages: 9
                Funding
                Funded by: Engineering and Physical Sciences Research, U.K.;
                Award ID: EP/520807/1
                This work was supported by the Engineering and Physical Sciences Research, U.K., under Grant EP/520807/1.
                Categories
                Regular Papers

                biomedical imaging,blood gas,electrical impedance tomography (eit),mechanical ventilation,respiratory system

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