Benefits of combining the measured values of intensive care ventilators with electrical impedance tomography results:

• fewer intra-hospital transfers of intensive care patients• quantifiable ventilation settings, adjustable under view• ventilation-associated complications can be detected and reduced• effects of therapeutic prone positioning under lung monitoring can be controlled for optimised

ventilation• tidal cyclic lung collapse can be detected and avoided• regional compliance can be analysed• overdistension can be identified and remedied by changing ventilator settings• best PEEP is adjustable in real time

Alliance for lung-protective ventilation of COVID-19 patients

Real-time images as well as EIT-based special lung function parameters sup-port clinicians with the regular eval-uation of the fluctuating pulmonary situation to adapt the ventilation to individual patient needs.

The elisa 800VIT device by Löwenstein Medical combines both functions: In-tensive care ventilation and EIT.

Assessment and monitoring of ventilation, stretch, regional compliance, regional tidal volume and size of available lung volume (functional lung size) can be performed continuously and easily, and the re-sults applied to ventilation strategies.

Electrical impedance tomography (EIT) is a bedside method that offers

reliable non-invasive assessment of regional lung function without

radiation exposure.

Further information on EIT technology is also available fromSenTec AG , EIT BranchSchulstrasse 1 7302 Landquart, Switzerland +41 81 330 09 70 info-eit@sentec.comwww.sentec.com

Individual lung protection under view

Strategies for lung-protective ventila-tion have become established practice based on modern scientific insights. Until recently, individual assessment based on a patient’s specific patho-physiological situation was not an op-tion.

See what matters: Silent Spaces

Overdistended lung tissue

Collapsed lung tissue

Functional lung regions available for ventilation

elisa 800VIT now enables real-time pulmonary as-sessment for the ongoing evaluation and adjust-ment of ventilation settings. That makes it feasible to identify and evaluate areas of tidal, cyclic collapse and overdistension.

elisa 800VIT

Number of electrodes 32

Reference electrode integrated

Electrode belt textile, breathable

Contact agent foam

Body position sensor integrated

Signal quality indicator yes

Signal filtering automatic

Additional work of breathing due to electrode belt

none

Image rate up to 50 images per second

Supply current < 3.7 mArms

Usage 72 hours

Organ contours yes

Trend analysis yes

Patient-specific inputs heightweightsexagechest circumference

Intelligent textiles avoid cross-contamination

First-generation EIT technologies used to be characterized by constricting electrode belts, reference electrodes and, de-pending on patient positioning, limited signal quality.

They have long been replaced by high-resolution electrodes embedded in textile belts and position angle sensors to detect a patient’s position. The technology now allows for real-time monitoring of ventilation and optimising respiratory therapy, even in prone position. The high resolution and individual or-gan contours generate a remarkable image display with intui-tive representation of the current situation.

Clinical Assessment

Adap

ting

Vent

ilatio

n

Ventilation Monitoring

Ventilator induced lung injury (VILI):

EIT can make an important contribution to controlling ventilation, particularly in the presence of inhomoge-neous lung tissue damage. EIT can display the dynamic changes in the lung tissue under ventilation with inho-mogeneous ventilation distribution, e.g. after a change in oxygen concentration.

EIT can make an important contribution to controlling ventilation, particularly in the presence of inhomoge-neous lung tissue damage. EIT can display the dynamic changes in the lung tissue under ventilation with inho-mogeneous ventilation distribution, e.g. after a recruit-ment manoeuvre.

The validity and reproducibility of parameters deter-mined with EIT has been evaluated in various studies and compared positively with other imaging and measuring techniques such as gas washout methods.

Grychtol B, Elke G, Meybohm B Weiler N, Frerichs I, Adler A. Functional validation and comparison frame-work for EIT lung imaging. PLoS One 2014;9:e103045.

Frerichs l, Dargaville PA, van Genderingen H, Morel DR, Rimensberger PC. Lung volume recruitment after surfactant administration modifies spatial dis-tribution of ventilation. Am J Respir crit care Med 2006;174172-9Odenstedt H, Lindgren S, Olegard C, et al. Slow moderate pressure recruitment maneuver mini-mizes negative circulatory and lung mechanic side effects: evaluation of recruitment maneuvers using electric impedance tomography. lntensive Care Med 2005;31:1706-14.

Hinz J, Moerer O, Neumann P, Dudykevych T, Hellige G, Quintel M. Effect of positive end-expiratory-pres-sure on regional ventilation in patients with acute lung injury evaluated by electrical impedance tomography. Eur J Anaesthesiol 2005;22:817-25

EIT can make an important contribution to controlling ventilation, particularly in the presence of inhomoge-neous lung tissue damage. EIT can display the dynamic changes in the lung tissue under ventilation with inho-mogeneous ventilation distribution, e.g. after adapting the tidal volume.

Zick G, Elke G, Becher T et al. Effect of PEEP and tidal volume on ventilation distribution and end-expirato-ry lung volume: a prospective experimental animal and pilot clinical study. PLoS 0ne 2013;8:e72675.

The validity and reproducibility of parameters deter-mined with EIT have been evaluated in various studies and compared positively with other imaging and meas-uring techniques such as vibration response imaging (VRI).

Chi C, Boehme S, Bentley AH, et al. Assessment of regional ventilation distribution: comparison of vibra-tion response imaging (VRl) with electrical imped-ance tomography (ElT). PLoS One 2014;9:e86638.

unsuitable ventilation settings

pathological distribution of ventilation

tidal cyclic overdistension

tidal cyclic collapse

alveolar collapse

Silent Spaces

inflammation

increased mortality

Clinical Assessment

Adap

ting

Vent

ilatio

n

Ventilation Monitoring

Ventilator induced lung injury (VILI):

The validity and reproducibility of parameters deter-mined with EIT have been evaluated in various studies and compared positively with other imaging and measur-ing techniques such as spirometry.

EIT can make an important contribution to controlling ventilation, particularly in the presence of inhomoge-neous lung tissue damage. EIT can display the dynamic changes in the lung tissue under ventilation with inho-mogeneous ventilation distribution, e.g. after a change in PEEP.

Reifferscheid E, Elke G, Pulletz S, et al. Regional ventila-tion distribution determined by electrical impedance tomography: reproductility and effects of posture and chest plane. Respirology 2011;16:523-31.Grivans C, Lundin S, Stenqvist O, Lindgren S. Positive end-expiratory pressure-induced changes in end-ex-piratory lung volume measured by spirometry and electric impedance tomography. Acta Anaesthesiol Scand 2011;55:1068-77.Coulombe N, Gagnon H, Marquis F, Skrobik Y, Guardo R. A parametric model of the relationship between EIT and total lung volume. Physiol Meas 2005;26:401-11.

Frerichs l, Dargaville PA, Dudykevych T, Rimensberger PC. Electrical impedance tomography: a method for monitoring regional lung aeration and tidal volume distribution? lntensive Care Med 2003;29:2312-6.Meier T, Luepschen H, Karsten J, et al. Assessment of regional lung recruitment and derecruitment during a PEEP trial based on electrical impedance tomography. lntensive Care Med 2008;34:543-50.Dargaville PA, Rimensberger PC, Frerichs l. Region-al tidal ventilation and compliance during a stepwise vital capacity manoeuvre. lntensive care medicine 2010;36:1953-61.

Combining the pixel characteristics of the EIT measure-ments with simultaneous airway pressure curves enables regional pressure-volume curves.

The validity and reproducibility of parameters deter-mined with EIT has been evaluated in various studies and compared positively with other imaging and meas-uring techniques such as single photon emission CT (SPECT).

Frerichs l, Dargaville PA, Rimensberger PC. Regional respiratory inflation and deflation pressure-volume curves determined by electrical impedance tomogra-phy. Physiol Meas 2013;34:567 -77.Miedema M, de Jongh FH, Frerichs l, van Veenendaal MB, van Kaam AH. Changes in lung volume and ventilation during surfactant treatment in venti-lated preterm infants. Am J Respir Crit Care Med 2011;184:100-5.

Hinz J, Neumann P, Dudykevych T, et al. Regional ven-tilation by electrical impedance tomography: a com-parison with ventilation scintigraphy in pigs. Chest 2003;124:314-22.

unsuitable ventilation settings

pathological distribution of ventilation

tidal cyclic overdistension

tidal cyclic collapse

alveolar collapse

Silent Spaces

inflammation

increased mortality

Minimize sources of interference:• Deactivate respiratory rate detection feature of the intensive-

care monitor.• Suspend continuous CO monitoring by means of Swan Ganz (the

electrical signals of the measurement may interfere with those of the EIT measurement)

Configure elisa 800VIT:• Start the EIT function by tapping on the animated lung.• Open the input screen by tapping on the signal display.• Enter patient data: - Body height - Actual weight - Sex - Age - Half of the chest circumference in cm

Check the settings and the SensorBelt:• Proper entry of patient data;• SensorBelt size matches the recommended size;• ContactAgent was applied correctly in accordance with

instructions;• SensorBelt is properly fitted to the body and correctly

positioned;• Signal quality is adequate;• Has SensorBelt been in use for less than 72 hours?

Evaluate potential contraindications:Rule out contraindications:• Open chest injuries• Non-intact skin or uncovered wounds in the chest area• Patients with active implants (such as pacemakers or

defibrillators)• Temporary pacemaker

NO use of electrical impedance tomography in the presence of known contraindications!

Apply SensorBelt according to instructions.

Prepare patient

NO

NO

Is this due to known morphological or functional conditions?• Pneumothorax • Pleural effusion • Bronchial obstruction • Unilateral intubation • Dislocated tube or tracheostomy tube • Morphology: resection of lung tissue, pulmonary agenesis

Select “Ventilation” view

YES

YES

Among other factors, rule out or address:- lung resection (agenesis)- lateral position of patient- (unilateral) phrenoplegia- (unilateral) diaphragm dysfunction- (unilateral) intra-abdominal process

Are both pulmonary sides ventilated similarly?

Consider further measures:• Therapeutic patient positioning (“down with the good lung”)• Bronchial hygiene• Additional diagnostics

NO

NO

Evaluate the results

Clear display without artefacts?

Does the ventilation predominantly take place within the displayed lung contours?

Structured bedside evaluation instead of scientific laboratory set-up

Kremeier,P.; Woll, Ch.; Pulletz, S. (2018): Algorithm-based monitoring of intensive-care ventilation using electrical impedance tomography, Pabst Publishers

Is this due to known morphological or functional conditions?• Pneumothorax • Pleural effusion • Bronchial obstruction • Unilateral intubation • Dislocated tube or tracheostomy tube • Morphology: resection of lung tissue, pulmonary agenesis

Select “Ventilation” view

Among other factors, rule out or address:- lung resection (agenesis)- lateral position of patient- (unilateral) phrenoplegia- (unilateral) diaphragm dysfunction- (unilateral) intra-abdominal process

YES

YES

Are both pulmonary sides ventilated similarly?

Consider further measures:• Therapeutic patient positioning (“down with the good lung”)• Bronchial hygiene• Additional diagnostics

Clear display without artefacts?

Does the ventilation predominantly take place within the displayed lung contours?

NO

NO

NO

Is the functional lung size (FLS) < 90%?

Are Silent Spaces mainly located in the upper, gravity-independent (ventral) area?

Are Silent Spaces mainly located in the lower, gravity-dependent (dorsal) area?

Analyse “Silent Spaces“ view

NO

YES

YES

YES

YES

Are there simultaneous Silent Spaces in the lower and upper areas of the lung?

Select the “Silent Spaces“ view

Possible common diagnoses: • Lung over-distension• Pneumothorax

Consider appropriate measures:• Reduce tidal volume (VT)• Lower inspiratory pressure (Pinsp.)• Reduce PEEP• Positioning therapy

Possible common diagnoses: • Atelectases• Pleural effusion

Consider appropriate measures:• Pleural effusion therapy• Increase PEEP• Alveolar recruitment manoeuvres • Positioning therapy

Consider appropriate measures:• Pleural effusion therapy

• Lung-protective ventilation with delta pressure (plateau - PEEP) < 15 cmH2O (achieved through high PEEP and small tidal volumes)

• Alveolar recruitment manoeuvres • Positioning therapy• Extracorporeal systems

Initiate further diagnostic or therapeutic measures depending on the findings. Initiate measures.

Continue EIT monitoring.

Structured bedside evaluation instead of scientific laboratory set-up

Exclusive distributor: Löwenstein Medical GmbH & Co. KGArzbacher Straße 8056130 Bad Ems, GermanyTel.: +49 26 03 96 00 0Fax: +49 26 03 96 00 50www.hul.de

Löwenstein Medical Innovation GmbH & Co. KG Niederhöchstädter Straße 6261476 Kronberg, GermanyT. +49 6173-9333-0F. +49 6173-9333-29www.loewensteinmedical.com

EIT accessories: Order no. LMI Order no. LM

VIT Starter Kit (incl. 3 x 2 belts + 6 x contact agent) BZ-370851 0400851

VIT SensorBelt

Size 1 80 cm (standard) CX-370856 0400856

Size 2 92 cm (standard) CX-370857 0400857

Size 3 104 cm (standard) CX-370858 0400858

Size 4 116 cm CX-370859 0400859

VIT Contact Agent (6 bottles) CX-370860 0400860

EIT Advanced Interface Set (VIT Simulator for SBC and LuMon) MG-800805

VIT – Update for elisa 800 please contact your sales representative

How does elisa 800 VIT support me with patient ventilation?

• Continuous lung monitoring fits seamlessly into the monitoring and care of ICU patients. • Prone positioning can be managed individually as needed instead of flying blind according to

standardized protocols.

How does elisa 800 VIT contribute to improved ventilation?

• Differentiated lung assessment is available at all times without radiation exposure and complex transport procedures.

• Individual lung protection can be implemented at a new level.

How does elisa 800 VIT contribute to cost optimization in hospitals?

• elisa 800VIT helps to recognize and avoid ventilation-associated complications at an early stage, which prevents follow-up costs.

• There is less need for intra-hospital transport of ventilated ICU patients, which is costly and prone to complications.

From the perspective of intensive care physicians

From the perspective of hospital management

From the perspective of intensive care nursing staff