Intensive Care Medicine

, Volume 35, Issue 6, pp 1132–1137 | Cite as

Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography

  • Eduardo L. V. Costa
  • João Batista Borges
  • Alexandre Melo
  • Fernando Suarez-Sipmann
  • Carlos ToufenJr
  • Stephan H. Bohm
  • Marcelo B. P. AmatoEmail author
Physiological and Technical Notes



To present a novel algorithm for estimating recruitable alveolar collapse and hyperdistension based on electrical impedance tomography (EIT) during a decremental positive end-expiratory pressure (PEEP) titration.


Technical note with illustrative case reports.


Respiratory intensive care unit.


Patients with acute respiratory distress syndrome.


Lung recruitment and PEEP titration maneuver.

Measurements and results

Simultaneous acquisition of EIT and X-ray computerized tomography (CT) data. We found good agreement (in terms of amount and spatial location) between the collapse estimated by EIT and CT for all levels of PEEP. The optimal PEEP values detected by EIT for patients 1 and 2 (keeping lung collapse <10%) were 19 and 17 cmH2O, respectively. Although pointing to the same non-dependent lung regions, EIT estimates of hyperdistension represent the functional deterioration of lung units, instead of their anatomical changes, and could not be compared directly with static CT estimates for hyperinflation.


We described an EIT-based method for estimating recruitable alveolar collapse at the bedside, pointing out its regional distribution. Additionally, we proposed a measure of lung hyperdistension based on regional lung mechanics.


Electrical impedance tomography Computed tomography Acute lung injury Acute respiratory distress syndrome Lung recruitment Positive end-expiratory pressure Mechanical ventilation 



Financial support by grants from “Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)”, São Paulo State Research Support Foundation and “Financiadora de Estudos e Projetos (FINEP)”, Studies and Projects Financial Support Provider and to Dixtal Biomédica, Ltda.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Eduardo L. V. Costa
    • 1
  • João Batista Borges
    • 1
  • Alexandre Melo
    • 1
  • Fernando Suarez-Sipmann
    • 2
  • Carlos ToufenJr
    • 1
  • Stephan H. Bohm
    • 1
  • Marcelo B. P. Amato
    • 1
    • 3
    Email author
  1. 1.Respiratory Intensive Care UnitUniversity of São Paulo School of MedicineSão PauloBrazil
  2. 2.Intensive Care UnitFundación Jiménez Días-CapioMadridSpain
  3. 3.Laboratório de Pneumologia LIM09Faculdade de Medicina da USPSão PauloBrazil

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