Clinical applications and research progress of electrical impedance tomography in perioperative respiratory management for adult cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAN Yueyue ¹ , LIU Siyu ¹ , ZHANG Xinyi ¹ , WANG Xiaoqi ¹ ,  CHANG Shuo ²

1. Department of Cardiac Surgery, Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102, P. R. China;
2. Department of Adult Cardiac Surgery Center, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;

Corresponding?author：

CHANG Shuo, Email: cschl@126.com

Keywords：

Electrical impedance tomography; cardiac surgery perioperative period; respiratory management; mechanical ventilation; postoperative pulmonary complications; positive end-expiratory pressure titration; review

DOI：

10.7507/1007-4848.202509064

Video：

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Abstract Full text Figures/Tables Video References Cited by

Electrical impedance tomography (EIT) is an emerging medical imaging technology characterized by its non-invasive nature, absence of ionizing radiation, real-time dynamic imaging capability, low cost, and portability. In recent years, significant progress has been made in the application of EIT for perioperative respiratory management in adult major surgeries, particularly in the context of postoperative pulmonary complications. This review focuses on adult cardiac surgery patients and explores the clinical value of EIT in addressing extracorporeal circulation-related lung injury, managing one-lung ventilation, and enabling early detection of postoperative complications (such as atelectasis, pneumothorax). It also discusses EIT’s core functions in perioperative monitoring and its added value in the context of cardiac surgery, providing insights for precision and personalized respiratory management.

1.	Frerichs I, Amato MBP, van Kaam AH, et al. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax, 2017, 72(1): 83-93.
2.	宋雨佳, 崔馨月, 王靜, 等. 電阻抗斷層成像在急危重癥醫學研究熱點與發展方向. 機械制造與自動化, 2024, 53(4): 1-6.Song YJ, Cui XY, Wang J, et al. Research hotspots and development directions of electrical impedance tomography in emergency and critical care medicine. Mach Build Autom, 2024, 53(4): 1-6.
3.	萬靜, 李興五, 高國忠. 基于深度學習的電阻抗斷層成像. 2023年中國地球科學聯合學術年會, 2023: 1.Wan J, Li XW, Gao GZ. Electrical impedance tomography based on deep learning. 2023 Annual Meeting of the Chinese Geoscience Union, 2023: 1.
4.	佘林君, 周睿, 潘盼, 等. 電阻抗斷層成像技術在肺灌注中的研究進展. 生物醫學工程學雜志, 2023, 40(6): 1249-1254.She LJ, Zhou R, Pan P, et al. Research progress on electrical impedance tomography in pulmonary perfusion. J Biomed Eng, 2023, 40(6): 1249-1254.
5.	Leonhardt S, Lachmann B. Electrical impedance tomography: the holy grail of ventilation and perfusion monitoring? Intensive Care Med, 2012, 38(12): 1917-1929.
6.	Jung T, Vij N. Early diagnosis and real-time monitoring of regional lung function changes to prevent chronic obstructive pulmonary disease progression to severe emphysema. J Clin Med, 2021, 10(24): 5811.
7.	Jiang HY, Li Q, Yu X, et al. Ventilation improvement after pneumonia treatment evaluated with electrical impedance tomography: an observational study. Physiol Meas, 2021, 42(10): 105010.
8.	趙倫, 阿德力江. 買買提明, 余雪淵, 等. 電阻抗斷層成像用于圍手術期呼吸管理的研究進展. 基礎醫學與臨床, 2024, 44(11): 1482-1486.Zhao L, Adilijiang Maimaitiming, Yu XY, et al. Research progress on electrical impedance tomography for perioperative respiratory management. Basic Clin Med, 2024, 44(11): 1482-1486.
9.	宋禮坡, 王春梅. 電阻抗斷層成像指導機械通氣呼吸末正壓設置的研究進展. 基礎醫學與臨床, 2024, 44(11): 1492-1498.Song LP, Wang CM. Research progress on electrical impedance tomography guiding positive end-expiratory pressure setting during mechanical ventilation. Basic Clin Med, 2024, 44(11): 1492-1498.
10.	賈利紅, 石超, 楊禮, 等. 肺部電阻抗斷層成像技術評估不同肌松拮抗劑對術后肺局部通氣恢復的影響. 復旦學報(醫學版), 2023, 50(1): 32-39,70.Jia LH, Shi C, Yang L, et al. Effects of different muscle relaxation antagonists on postoperative local lung ventilation recovery evaluated by pulmonary electrical impedance tomography. Fudan Univ J Med Sci, 2023, 50(1): 32-39,70.
11.	Ma X, Fu Y, Piao X, et al. Individualised positive end-expiratory pressure titrated intra-operatively by electrical impedance tomography optimises pulmonary mechanics and reduces postoperative atelectasis: a randomised controlled trial. Eur J Anaesthesiol, 2023, 40(11): 805-816.
12.	Shu B, Zhang Y, Ren Q, et al. Optimal positive end-expiratory pressure titration of intraoperative mechanical ventilation in different operative positions of female patients under general anesthesia. Heliyon, 2023, 9(10): e20552.
13.	Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
14.	Gao Y, He H, Chi Y, et al. Electrical impedance tomography guided positive end-expiratory pressure titration in critically ill and surgical adult patients: a systematic review and meta-analysis. BMC Pulm Med, 2024, 24(1): 582.
15.	Chen L, Yu K, Yang J, et al. Electrical impedance tomography-guided positive end-expiratory pressure titration for perioperative oxygenation and postoperative pulmonary complications: a systematic review and meta-analysis. Medicine (Baltimore), 2024, 103(52): e40357.
16.	Heines SJH, de Jongh SAM, Strauch U, et al. The global inhomogeneity index assessed by electrical impedance tomography overestimates PEEP requirement in patients with ARDS: an observational study. BMC Anesthesiol, 2022, 22(1): 258.
17.	van Oosten JP, Francovich JE, Somhorst P, et al. Flow-controlled ventilation decreases mechanical power in postoperative ICU patients. Intensive Care Med Exp, 2024, 12(1): 30.
18.	Xiao Z, Yang L, Dai M, et al. Regional ventilation distribution before and after laparoscopic lung parenchymal resection. Physiol Meas, 2024, 45(1): 015001.
19.	Bauer M, Opitz A, Filser J, et al. Perioperative redistribution of regional ventilation and pulmonary function: a prospective observational study in two cohorts of patients at risk for postoperative pulmonary complications. BMC Anesthesiol, 2019, 19(1): 132.
20.	van den Berg MJW, Heunks L, Doorduin J. Advances in achieving lung and diaphragm-protective ventilation. Curr Opin Crit Care, 2025, 31(1): 38-46.
21.	Song X, Yang D, Yang M, et al. Effect of electrical impedance tomography-guided early mobilization in patients after major upper abdominal surgery: protocol for a prospective cohort study. Front Med (Lausanne), 2021, 8: 710463.
22.	Gao Z, Yang L, Zhao Z, et al. Monitoring of spontaneous pneumothorax using electrical impedance tomography: a case report. Heliyon, 2024, 10(3): e25405.
23.	Yang Y, He H, Long Y, et al. Bedside electrical impedance tomography in early diagnosis of pneumothorax in mechanically ventilated ICU patients - a single-center retrospective cohort study. J Clin Monit Comput, 2023, 37(2): 629-637.
24.	Kuk WJ, Wright NR. Bedside diagnosis of pulmonary embolism using electrical impedance tomography: a case report. A A Pract, 2022, 16(7): e01606.
25.	蔡秋燕, 劉旺林, 程衛, 等. 床旁高滲鹽水造影肺灌注電阻抗斷層成像技術在肺動脈內膜剝脫術后應用2例并文獻復習. 協和醫學雜志, 2025, 16(2): 513-518.Cai QY, Liu WL, Cheng W, et al. Application of bedside hypertonic saline-contrast electrical impedance tomography of lung perfusion in patients after pulmonary endarterectomy: two cases and literature review. Med J Peking Union Med Coll Hosp, 2025, 16(2): 513-518.
26.	Becher T, Bussmeyer M, Lautenschlager I, et al. Characteristic pattern of pleural effusion in electrical impedance tomography images of critically ill patients. Br J Anaesth, 2018, 120(6): 1219-1228.
27.	Rara A, Roubik K, Tyll T. Effects of pleural effusion drainage in the mechanically ventilated patient as monitored by electrical impedance tomography and end-expiratory lung volume: a pilot study. J Crit Care, 2020, 59: 76-80.
28.	Kogan A, Segel MJ, Ram E, et al. Acute respiratory distress syndrome following cardiac surgery: comparison of the American-European Consensus Conference definition versus the Berlin definition. Respiration, 2019, 97(6): 518-524.
29.	Gajic O, Dabbagh O, Park PK, et al. Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med, 2011, 183(4): 462-470.
30.	Lehmann M, Oehler B, Zuber J, et al. Redistribution of pulmonary ventilation after lung surgery detected with electrical impedance tomography. Acta Anaesthesiol Scand, 2020, 64(4): 517-525.
31.	Yeo HJ, Kim HY, Je HG, et al. Electrical impedance tomography-based evaluation of regional lung ventilation according to ventilation strategy during cardiopulmonary bypass in minimally invasive cardiac surgery: a prospective randomized controlled trial. J Thorac Dis, 2025, 17(6): 3912-3923.
32.	Blankman P, van der Kooij SM, Gommers D. Tidal ventilation distribution during pressure-controlled ventilation and pressure support ventilation in post-cardiac surgery patients. Acta Anaesthesiol Scand, 2014, 58(8): 997-1006.
33.	Iwata H, Yoshida T, Hoshino T, et al. Electrical impedance tomography-based ventilation patterns in patients after major surgery. Am J Respir Crit Care Med, 2024, 209(11): 1328-1337.
34.	Karsten J, Grusnick C, Paarmann H, et al. Positive end-expiratory pressure titration at bedside using electrical impedance tomography in post-operative cardiac surgery patients. Acta Anaesthesiol Scand, 2015, 59(6): 723-732.
35.	Bito K, Shono A, Kimura S, et al. Clinical implications of determining individualized positive end-expiratory pressure using electrical impedance tomography in post-cardiac surgery patients: a prospective, non-randomized interventional study. J Clin Med, 2022, 11(11): 3145.
36.	Blankman P, Hasan D, Gommers D, et al. Detection of 'best' positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial. Crit Care, 2014, 18(3): R95.
37.	Zhou R, He C, Chi Y, et al. Electrical impedance tomography to aid in the identification of hypoxemia etiology: massive atelectasis or pneumothorax? A case report. Front Med (Lausanne), 2022, 9: 970087.

1. Frerichs I, Amato MBP, van Kaam AH, et al. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax, 2017, 72(1): 83-93.
2. 宋雨佳, 崔馨月, 王靜, 等. 電阻抗斷層成像在急危重癥醫學研究熱點與發展方向. 機械制造與自動化, 2024, 53(4): 1-6.Song YJ, Cui XY, Wang J, et al. Research hotspots and development directions of electrical impedance tomography in emergency and critical care medicine. Mach Build Autom, 2024, 53(4): 1-6.
3. 萬靜, 李興五, 高國忠. 基于深度學習的電阻抗斷層成像. 2023年中國地球科學聯合學術年會, 2023: 1.Wan J, Li XW, Gao GZ. Electrical impedance tomography based on deep learning. 2023 Annual Meeting of the Chinese Geoscience Union, 2023: 1.
4. 佘林君, 周睿, 潘盼, 等. 電阻抗斷層成像技術在肺灌注中的研究進展. 生物醫學工程學雜志, 2023, 40(6): 1249-1254.She LJ, Zhou R, Pan P, et al. Research progress on electrical impedance tomography in pulmonary perfusion. J Biomed Eng, 2023, 40(6): 1249-1254.
5. Leonhardt S, Lachmann B. Electrical impedance tomography: the holy grail of ventilation and perfusion monitoring? Intensive Care Med, 2012, 38(12): 1917-1929.
6. Jung T, Vij N. Early diagnosis and real-time monitoring of regional lung function changes to prevent chronic obstructive pulmonary disease progression to severe emphysema. J Clin Med, 2021, 10(24): 5811.
7. Jiang HY, Li Q, Yu X, et al. Ventilation improvement after pneumonia treatment evaluated with electrical impedance tomography: an observational study. Physiol Meas, 2021, 42(10): 105010.
8. 趙倫, 阿德力江. 買買提明, 余雪淵, 等. 電阻抗斷層成像用于圍手術期呼吸管理的研究進展. 基礎醫學與臨床, 2024, 44(11): 1482-1486.Zhao L, Adilijiang Maimaitiming, Yu XY, et al. Research progress on electrical impedance tomography for perioperative respiratory management. Basic Clin Med, 2024, 44(11): 1482-1486.
9. 宋禮坡, 王春梅. 電阻抗斷層成像指導機械通氣呼吸末正壓設置的研究進展. 基礎醫學與臨床, 2024, 44(11): 1492-1498.Song LP, Wang CM. Research progress on electrical impedance tomography guiding positive end-expiratory pressure setting during mechanical ventilation. Basic Clin Med, 2024, 44(11): 1492-1498.
10. 賈利紅, 石超, 楊禮, 等. 肺部電阻抗斷層成像技術評估不同肌松拮抗劑對術后肺局部通氣恢復的影響. 復旦學報(醫學版), 2023, 50(1): 32-39,70.Jia LH, Shi C, Yang L, et al. Effects of different muscle relaxation antagonists on postoperative local lung ventilation recovery evaluated by pulmonary electrical impedance tomography. Fudan Univ J Med Sci, 2023, 50(1): 32-39,70.
11. Ma X, Fu Y, Piao X, et al. Individualised positive end-expiratory pressure titrated intra-operatively by electrical impedance tomography optimises pulmonary mechanics and reduces postoperative atelectasis: a randomised controlled trial. Eur J Anaesthesiol, 2023, 40(11): 805-816.
12. Shu B, Zhang Y, Ren Q, et al. Optimal positive end-expiratory pressure titration of intraoperative mechanical ventilation in different operative positions of female patients under general anesthesia. Heliyon, 2023, 9(10): e20552.
13. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
14. Gao Y, He H, Chi Y, et al. Electrical impedance tomography guided positive end-expiratory pressure titration in critically ill and surgical adult patients: a systematic review and meta-analysis. BMC Pulm Med, 2024, 24(1): 582.
15. Chen L, Yu K, Yang J, et al. Electrical impedance tomography-guided positive end-expiratory pressure titration for perioperative oxygenation and postoperative pulmonary complications: a systematic review and meta-analysis. Medicine (Baltimore), 2024, 103(52): e40357.
16. Heines SJH, de Jongh SAM, Strauch U, et al. The global inhomogeneity index assessed by electrical impedance tomography overestimates PEEP requirement in patients with ARDS: an observational study. BMC Anesthesiol, 2022, 22(1): 258.
17. van Oosten JP, Francovich JE, Somhorst P, et al. Flow-controlled ventilation decreases mechanical power in postoperative ICU patients. Intensive Care Med Exp, 2024, 12(1): 30.
18. Xiao Z, Yang L, Dai M, et al. Regional ventilation distribution before and after laparoscopic lung parenchymal resection. Physiol Meas, 2024, 45(1): 015001.
19. Bauer M, Opitz A, Filser J, et al. Perioperative redistribution of regional ventilation and pulmonary function: a prospective observational study in two cohorts of patients at risk for postoperative pulmonary complications. BMC Anesthesiol, 2019, 19(1): 132.
20. van den Berg MJW, Heunks L, Doorduin J. Advances in achieving lung and diaphragm-protective ventilation. Curr Opin Crit Care, 2025, 31(1): 38-46.
21. Song X, Yang D, Yang M, et al. Effect of electrical impedance tomography-guided early mobilization in patients after major upper abdominal surgery: protocol for a prospective cohort study. Front Med (Lausanne), 2021, 8: 710463.
22. Gao Z, Yang L, Zhao Z, et al. Monitoring of spontaneous pneumothorax using electrical impedance tomography: a case report. Heliyon, 2024, 10(3): e25405.
23. Yang Y, He H, Long Y, et al. Bedside electrical impedance tomography in early diagnosis of pneumothorax in mechanically ventilated ICU patients - a single-center retrospective cohort study. J Clin Monit Comput, 2023, 37(2): 629-637.
24. Kuk WJ, Wright NR. Bedside diagnosis of pulmonary embolism using electrical impedance tomography: a case report. A A Pract, 2022, 16(7): e01606.
25. 蔡秋燕, 劉旺林, 程衛, 等. 床旁高滲鹽水造影肺灌注電阻抗斷層成像技術在肺動脈內膜剝脫術后應用2例并文獻復習. 協和醫學雜志, 2025, 16(2): 513-518.Cai QY, Liu WL, Cheng W, et al. Application of bedside hypertonic saline-contrast electrical impedance tomography of lung perfusion in patients after pulmonary endarterectomy: two cases and literature review. Med J Peking Union Med Coll Hosp, 2025, 16(2): 513-518.
26. Becher T, Bussmeyer M, Lautenschlager I, et al. Characteristic pattern of pleural effusion in electrical impedance tomography images of critically ill patients. Br J Anaesth, 2018, 120(6): 1219-1228.
27. Rara A, Roubik K, Tyll T. Effects of pleural effusion drainage in the mechanically ventilated patient as monitored by electrical impedance tomography and end-expiratory lung volume: a pilot study. J Crit Care, 2020, 59: 76-80.
28. Kogan A, Segel MJ, Ram E, et al. Acute respiratory distress syndrome following cardiac surgery: comparison of the American-European Consensus Conference definition versus the Berlin definition. Respiration, 2019, 97(6): 518-524.
29. Gajic O, Dabbagh O, Park PK, et al. Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med, 2011, 183(4): 462-470.
30. Lehmann M, Oehler B, Zuber J, et al. Redistribution of pulmonary ventilation after lung surgery detected with electrical impedance tomography. Acta Anaesthesiol Scand, 2020, 64(4): 517-525.
31. Yeo HJ, Kim HY, Je HG, et al. Electrical impedance tomography-based evaluation of regional lung ventilation according to ventilation strategy during cardiopulmonary bypass in minimally invasive cardiac surgery: a prospective randomized controlled trial. J Thorac Dis, 2025, 17(6): 3912-3923.
32. Blankman P, van der Kooij SM, Gommers D. Tidal ventilation distribution during pressure-controlled ventilation and pressure support ventilation in post-cardiac surgery patients. Acta Anaesthesiol Scand, 2014, 58(8): 997-1006.
33. Iwata H, Yoshida T, Hoshino T, et al. Electrical impedance tomography-based ventilation patterns in patients after major surgery. Am J Respir Crit Care Med, 2024, 209(11): 1328-1337.
34. Karsten J, Grusnick C, Paarmann H, et al. Positive end-expiratory pressure titration at bedside using electrical impedance tomography in post-operative cardiac surgery patients. Acta Anaesthesiol Scand, 2015, 59(6): 723-732.
35. Bito K, Shono A, Kimura S, et al. Clinical implications of determining individualized positive end-expiratory pressure using electrical impedance tomography in post-cardiac surgery patients: a prospective, non-randomized interventional study. J Clin Med, 2022, 11(11): 3145.
36. Blankman P, Hasan D, Gommers D, et al. Detection of 'best' positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial. Crit Care, 2014, 18(3): R95.
37. Zhou R, He C, Chi Y, et al. Electrical impedance tomography to aid in the identification of hypoxemia etiology: massive atelectasis or pneumothorax? A case report. Front Med (Lausanne), 2022, 9: 970087.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesClinical applications and research progress of electrical impedance tomography in perioperative respiratory management for adult cardiac surgery

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