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In patients undergoing spontaneous breathing (SB) deep sedation there is a re-distribution of ventilation towards lungs non-dependant areas (ventral areas in supine position).
Non-invasive ventilation (NIV), offering positive pressure, should favour a better ventilation of dependant areas (dorsal areas in supine position), making ventilation more homogeneous and increasing functional residual capacity.
Electrical impedance tomography (EIT) is a non-invasive, non-operator dependent, bedside, radiations-free diagnostic tool, feasible in paediatric patients and repeatable; it allows to study ventilation distribution, and it can measure and calculate also parameters that are related to the homogeneity of ventilation and the response to certain therapeutic maneuvers, such as anaesthesia or PEEP-application.
Uses of EIT in paediatric age are described in literature, but it has never been described as being used in Non-Operating Room Anaesthesia, nor in other cases of SB deep sedation. In addition, the impact of NIV on the distribution of ventilation in healthy paediatric patients undergoing deep sedation has never been described.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Spontaneous breathing | Active Comparator | Electrical impedance tomography (EIT). |
|
| CPAP mode | Active Comparator | Electrical impedance tomography (EIT). |
|
| NIV- S/T mode | Active Comparator | Electrical impedance tomography (EIT). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| EIT | Device | Evaluation of ventilation distrinution during deep sedation through EIT |
|
| Measure | Description | Time Frame |
|---|---|---|
| Regional Ventilation Delay (pixels %), RDV | It's an index of atelectrauma, supra-distension and in general an inhomogeneous ventilation | 1 day |
| Measure | Description | Time Frame |
|---|---|---|
| Inhomogeneity Index (pixels), GI | 1 day | |
| Gravity Centre(pixels %), GC | 1 day |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Giovanna Chidini, MD | Contact | 0255032242 | giovanna.chidini@policlinico.mi.it | |
| Stefano Scalia Catenacci, MD | Contact | 0255032242 | stefano.scaliacatenacci@policlinico.mi.it |
| Name | Affiliation | Role |
|---|---|---|
| Giovanna Chidini | Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano | Recruiting | Milan | 20122 | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22992946 | Background | Leonhardt S, Lachmann B. Electrical impedance tomography: the holy grail of ventilation and perfusion monitoring? Intensive Care Med. 2012 Dec;38(12):1917-29. doi: 10.1007/s00134-012-2684-z. Epub 2012 Sep 20. | |
| 19652949 | Background | Zhao Z, Moller K, Steinmann D, Frerichs I, Guttmann J. Evaluation of an electrical impedance tomography-based Global Inhomogeneity Index for pulmonary ventilation distribution. Intensive Care Med. 2009 Nov;35(11):1900-6. doi: 10.1007/s00134-009-1589-y. Epub 2009 Aug 4. |
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| ID | Term |
|---|---|
| D012131 | Respiratory Insufficiency |
| C564247 | Microcephaly, Primary Autosomal Recessive, 6 |
| ID | Term |
|---|---|
| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
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| 31390977 | Background | Spinelli E, Mauri T, Fogagnolo A, Scaramuzzo G, Rundo A, Grieco DL, Grasselli G, Volta CA, Spadaro S. Electrical impedance tomography in perioperative medicine: careful respiratory monitoring for tailored interventions. BMC Anesthesiol. 2019 Aug 7;19(1):140. doi: 10.1186/s12871-019-0814-7. |
| 27687426 | Background | Bordes J, Goutorbe P, Cungi PJ, Boghossian MC, Kaiser E. Noninvasive ventilation during spontaneous breathing anesthesia: an observational study using electrical impedance tomography. J Clin Anesth. 2016 Nov;34:420-6. doi: 10.1016/j.jclinane.2016.04.016. Epub 2016 Jun 16. |
| 21395895 | Background | Humphreys S, Pham TM, Stocker C, Schibler A. The effect of induction of anesthesia and intubation on end-expiratory lung level and regional ventilation distribution in cardiac children. Paediatr Anaesth. 2011 Aug;21(8):887-93. doi: 10.1111/j.1460-9592.2011.03547.x. Epub 2011 Mar 14. |
| 40119601 | Derived | Chidini G, Marchesi T, Catenacci SS, Florio G, Conti G, Lanni S, Filocamo G, Patria F, Guerrini M, Milani G, Grasselli G. Effects of Noninvasive Respiratory Support on Ventilation Distribution During Spontaneous Breathing Sedation in Preschool/School-Aged Children: An Electrical Impedance Tomography Study. Paediatr Anaesth. 2025 Jul;35(7):562-572. doi: 10.1111/pan.15098. Epub 2025 Mar 22. |