Electrical Impedance Tomography-Guided Synergistic Intervention of Respiratory Muscle Training and Postural Adjustment for Lung Recruitment in Critically Ill Patients With Respiratory Failure.

Abstract

Lung collapse and ventilation heterogeneity are common in mechanically ventilated critically ill patients. Electrical impedance tomography (EIT) enables real-time bedside monitoring of regional ventilation and may facilitate individualized respiratory management. This study evaluated the effect of EIT-guided respiratory muscle training (RMT) combined with postural adjustment on lung recruitment in patients with respiratory failure. In this single-center, prospective, randomized controlled trial, 150 patients were randomly assigned to three groups: the EIT collaborative group (EIT-guided RMT+postural adjustment), the EIT posture group (EIT-guided positioning only), and the conventional collaborative group (RMT+postural adjustment without EIT). The primary endpoint was the change in end-expiratory lung impedance (EELI). Secondary outcomes included oxygenation, respiratory mechanics, ventilation homogeneity, and clinical outcomes. Data were analyzed using ANOVA and linear mixed-effects models. The interventions were applied for up to 5 consecutive days after randomization or until ICU discharge, whichever occurred first. After 5 days, EELI increased by 18.4±7.6 % in the EIT collaborative group, which was significantly greater than the increases observed in the EIT posture group (9.1±6.2 %) and the conventional collaborative group (3.7±5.8 %) (P<0.001). CL % decreased markedly without a significant increase in OD %, while CoV and GI index indicated improved ventilation uniformity. The EIT collaborative group also showed favorable trends toward improved oxygenation and respiratory mechanics, along with shorter ventilation duration and higher extubation success rates. A significant interaction between EIT supervision intensity and intervention level was confirmed (F=6.45, P=0.011). No serious adverse events occurred. These findings suggest that EIT-guided RMT combined with postural adjustment may enhance lung recruitment and ventilation homogeneity, with potential benefits for respiratory mechanics and selected short-term clinical outcomes. Real-time EIT feedback may provide a safe, individualized strategy for respiratory rehabilitation in critically ill patients.