Impact of electrical impedance tomography in the application of pulmonary rehabilitation in patients with hospital-acquired pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Yi , LI Qing , NIU Guangyu , LIU Zhongnan , XI Jianing ,  JIANG Hongying

Department of Pulmonary and Critical Care Medicine, Beijing Rehabilitation Hospital of Capital Medical University, Beijing 100144, P. R. China;

Corresponding?author：

JIANG Hongying, Email: 6jhy@163.com

Keywords：

Electrical impedance tomography; hospital-acquired pneumonia; pulmonary rehabilitation

DOI：

10.7507/1671-6205.202201045

Video：

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Objective To investigate the impact of electrical impedance tomography (EIT) as a means of assessing and guiding pulmonary rehabilitation chest physiotherapy (CPT) in hospital-acquired pneumonia (HAP) patients on the time to symptom improvement, cost of hospitalisation, length of stay and patient satisfaction with pulmonary rehabilitation. Methods Ninety-six patients with HAP requiring pulmonary rehabilitation were included in the study and were divided into control group and experimental group using the random number table method. Patients in both groups underwent pulmonary rehabilitation CPT in addition to clinical treatment for HAP, twice daily for 20 minutes each time. EIT was added to experimental group as a means of assessment and guidance, with dynamic review prior to treatment and real-time adjustment of treatment based on the results. The primary outcome indicator was a comparison of the change in clinical pulmonary infection score (CPIS) after the start of treatment in both groups, and secondary outcome indicators were a comparison of the length of HAP hospitalisation, HAP-related cost, and patient satisfaction with pulmonary rehabilitation in both groups. Results During the study, 8 patients terminated airway clearance due to the aggravation of the disease, and 1 patient referral. Finally, 43 patients in the study control group and 44 patients in the experimental group were included. There was a significant difference in CPIS between the test group and the control group on 3rd and 7th day after starting airway clearance (P<0.05). Compared with the control group, there were significant differences in the length of HAP hospitalisation, HAP-related cost, and patient satisfaction with airway clearance in the test group (P<0.01). Conclusion The use of EIT allows real-time visual monitoring of the distribution of lung ventilation in HAP patients, thus guiding individualized pulmonary rehabilitation treatment, which can shorten the time to symptom improvement, reduce the length and cost of HAP hospitalisation and significantly improve patient satisfaction and compliance with pulmonary rehabilitation.

Citation： LI Yi, LI Qing, NIU Guangyu, LIU Zhongnan, XI Jianing, JIANG Hongying. Impact of electrical impedance tomography in the application of pulmonary rehabilitation in patients with hospital-acquired pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(2): 83-88. doi: 10.7507/1671-6205.202201045 Copy

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1. Modi AR, Kovacs CS. Hospital-acquired and ventilator-associated pneumonia: diagnosis, management, and prevention. Cleve Clin J Med, 2020, 87(10): 633-639.
2. Suaya JA, Fletcher MA, Georgalis L, et al. Identification of Streptococcus pneumoniae in hospital-acquired pneumonia in adults. J Hosp Infect, 2021, 108: 146-157.
3. Rosenthal VD, Maki DG, Mehta Y, et al. International Nosocomial Infection Control Consortium. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module. Am J Infect Control, 2014, 42(9): 942-956.
4. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
5. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med, 2014, 370(13): 1198-1208.
6. Koulenti D, Lisboa T, Brun-Buisson C, et al. Spectrum of practice in the diagnosis of nosocomial pneumonia in patients requiring mechanical ventilation in European intensive care units. Crit Care Med, 2009, 37(8): 2360-2368.
7. Giuliano KK, Baker D, Quinn B. The epidemiology of nonventilator hospital-acquired pneumonia in the United States. Am J Infect Control, 2018, 46(3): 322-327.
8. Yang M, Yan YP, Yin XL, et al. Chest physiotherapy for pneumonia in adults. Cochrane Database Syst Rev, 2010, (2): CD006338.
9. McAlinden B, Kuys S, Schibler A, et al. Chest physiotherapy improves regional lung volume in ventilated children. Crit Care, 2020, 24(1): 440.
10. Shi Y, Yang ZG, Xie F, et al. The research progress of electrical impedance tomography for lung monitoring. Front Bioeng Biotechnol, 2021, 9: 726652.
11. Nishimura M. Electrical Impedance Tomography: The Promise of Noninvasive Lung Images at the Bedside. Respir Care, 2020, 65(3): 402-403.
12. 中華醫學會呼吸病學分會感染學組. 中國成人醫院獲得性肺炎與呼吸機相關性肺炎診斷和治療指南(2018年版). 中華結核和呼吸雜志, 2018, 41(4): 255-280.
13. 何禮賢. 重癥醫院獲得性肺炎的診治與控制. 中華內科雜志, 2001, 40(3): 145-147.
14. Belli S, Prince I, Savio G, et al. Airway clearance techniques: the right choice for the right patient. Front Med (Lausanne), 2021, 8: 544826.
15. He HW, Chi Y, Long Y, et al. Three broad classifications of acute respiratory failure etiologies based on regional ventilation and perfusion by electrical impedance tomography: a hypothesis-generating study. Ann Intensive Care, 2021, 11(1): 134.
16. Torres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT Guidelines for the Management of Hospital-acquired Pneumonia and Ventilator-associated Pneumonia: Guidelines for the Management of Hospital-acquired pneumonia (HAP)/Ventilator-associated Pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J, 2017, 50(3): 1700582.
17. Frownfelter D, Dean E. Cardiovascular and Pulmonary Physical Therapy: Evidence to Practice, 5th edn. St. Louis: Elsevier, 2012, 309-339.
18. Alison J, Barrack C, Cafarella P, et al. The Australian Lung Foundation pulmonary rehabilitation toolkit[EB/OL]. (2009). Retrieved from: http://www.pulmonaryrehab.com.au/welcome.asp.
19. 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): abffbf.
20. Fahy JV, Dickey BF. Airway mucus function and dysfunction. N Engl J Med, 2010, 363(23): 2233-2347.
21. Longhini F, Bruni A, Garofalo E, et al. Chest physiotherapy improves lung aeration in hypersecretive critically ill patients: a pilot randomized physiological study. Crit Care, 2020, 24(1): 479.
22. Freitas DA, Chaves GS, Santino TA, et al. Standard (head-down tilt) versus modified (without head-down tilt) postural drainage in infants and young children with cystic fibrosis. Cochrane Database Syst Rev, 2018, 3(3): CD010297.
23. üzmezo?lu B, Alt?ay G, ?zdemir L, et al. The efficacy of Flutter? and active cycle of breathing techniques in patients with bronchiectasis: a prospective, randomized, comparative study. Turk Thorac J, 2018, 19(3): 103-109.
24. Muscedere JG, Day A, Heyland DK. Mortality, attributable mortality, and clinical events as end points for clinical trials of ventilator-associated pneumonia and hospital-acquired pneumonia. Clin Infect Dis, 2010, 51(Suppl 1): S120-S125.
25. Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol, 2012, 33(3): 250-256.
26. 劉又寧, 曹彬, 王輝, 等. 中國九城市成人醫院獲得性肺炎微生物學與臨床特點調查. 中華結核和呼吸雜志, 2012, 35(10): 739-746.
27. Janssens W, Corhay JL, Bogaerts P, et al. How resources determine pulmonary rehabilitation programs: a survey among Belgian chest physicians. Chron Respir Dis, 2019, 16: 1479972318767732.
28. 叢舒, 王寧, 樊靜, 等. 2014-2015年中國40歲及以上慢性阻塞性肺疾病患者呼吸康復治療情況. 中華流行病學雜志, 2020, 41(7): 1014-1020.
29. Troosters T, Blondeel A, Janssens W, et al. The past, present and future of pulmonary rehabilitation. Respirology, 2019, 24(9): 830-837.

Chinese Journal of Respiratory and Critical Care Medicine

Impact of electrical impedance tomography in the application of pulmonary rehabilitation in patients with hospital-acquired pneumonia

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