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Bissett et al. proposed a list of indications when to apply IMT including patients
awareness, fraction of inspired oxygen, and respiratory rate, which are not direct
measures of muscle activities. The training intensity can be monitored with maximum
inspiratory pressure, which needs to be measured invasively through the tracheostomy
or using an endotracheal tube and not suitable for patients who are recently weaned.
Therefore, a continuous bedside tool is warranted to assess the inspiratory muscle
status and the efficacy of IMT. We recently monitored the weaning process in patients
with prolonged mechanical ventilation using electrical impedance tomography (EIT).
The results of our study imply that EIT may monitor muscle activities during IMT
process and identify the patients at risk of weaning failure. To be specific, we found
that intratidal ventilation redistribution detected improvement or muscle fatigue
during IMT (Fig. 1). Typically, the lower the support level is, the higher the percentage of ventilation
became in dorsal regions in patients who were successfully weaned. On the contrary,
a decrease in ventilation (instead of increase) in dorsal regions with lower support
level indicated early respiratory distress (see last row in Fig. 1). We believe that by monitoring the intratidal ventilation redistribution in real
time at the bedside, patients who require IMT can be identified. Besides, Bissett
et al. mentioned that there are different IMT approaches available, in which the effects
and tolerances vary in different patient populations.
Thank you for the opportunity to respond to the interesting letter from Zhao et al. about the potential role of electrical impedance tomography (EIT) in inspiratory muscle training (IMT) in intensive care unit (ICU) patients.1 We agree that EIT may prove a vital adjunct to the toolbox for ICU clinicians. For example, EIT has already been used to identify changes in distribution of ventilation during airway suction.2 However most ICUs do not yet have access to this technology, and our guideline was written for simplicity and generalisability.