{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T20:12:34Z","timestamp":1788811954316,"version":"build-2803163510"},"reference-count":22,"publisher":"Institute of Physiology of the Czech Academy of Sciences","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Physiol Res"],"abstract":"<jats:p>Lung collapse and ventilation heterogeneity are common in mechanically ventilated critically ill patients. Electrical impedance tomography (EIT) enables real-time bedside monitoring of regional ventilation and may facilitate individualized respiratory management. This study evaluated the effect of EIT-guided respiratory muscle training (RMT) combined with postural adjustment on lung recruitment in patients with respiratory failure. In this single-center, prospective, randomized controlled trial, 150 patients were randomly assigned to three groups: the EIT collaborative group (EIT-guided RMT+postural adjustment), the EIT posture group (EIT-guided positioning only), and the conventional collaborative group (RMT+postural adjustment without EIT). The primary endpoint was the change in end-expiratory lung impedance (EELI). Secondary outcomes included oxygenation, respiratory mechanics, ventilation homogeneity, and clinical outcomes. Data were analyzed using ANOVA and linear mixed-effects models. The interventions were applied for up to 5 consecutive days after randomization or until ICU discharge, whichever occurred first. After 5 days, EELI increased by 18.4\u00b17.6 % in the EIT collaborative group, which was significantly greater than the increases observed in the EIT posture group (9.1\u00b16.2 %) and the conventional collaborative group (3.7\u00b15.8 %) (P&lt;0.001). CL % decreased markedly without a significant increase in OD %, while CoV and GI index indicated improved ventilation uniformity. The EIT collaborative group also showed favorable trends toward improved oxygenation and respiratory mechanics, along with shorter ventilation duration and higher extubation success rates. A significant interaction between EIT supervision intensity and intervention level was confirmed (F=6.45, P=0.011). No serious adverse events occurred. These findings suggest that EIT-guided RMT combined with postural adjustment may enhance lung recruitment and ventilation homogeneity, with potential benefits for respiratory mechanics and selected short-term clinical outcomes. Real-time EIT feedback may provide a safe, individualized strategy for respiratory rehabilitation in critically ill patients.<\/jats:p>","DOI":"10.33549\/physiolres.935744","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T19:46:05Z","timestamp":1788810365000},"page":"759","source":"Crossref","is-referenced-by-count":0,"title":["Electrical Impedance Tomography-Guided Synergistic Intervention of Respiratory Muscle Training and Postural Adjustment for Lung Recruitment in Critically Ill Patients With Respiratory Failure"],"prefix":"10.33549","volume":"75","author":[{"given":"Hongfei","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Intensive Care Unit, Tianjin First Central Hospital, Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhu","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongmei","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"19169","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"1.\tKyle JM, Sturza JM, Dechert RE, Custer JR, Dahmer MK, Saba TG, et al. Clinical outcomes of acute respiratory failure associated with noninvasive and invasive ventilation in a pediatric ICU. Respir Care 2022;67:956-966. https:\/\/doi.org\/10.4187\/respcare.09348","DOI":"10.4187\/respcare.09348"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"2.\tMirabella L, Cinnella G, Costa R, Cortegiani A, Tullo L, Rauseo M, et al. Patient-ventilator asynchronies: clinical implications and practical solutions. Respir Care 2020;65:1751-1766. https:\/\/doi.org\/10.4187\/respcare.07284","DOI":"10.4187\/respcare.07284"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"3.\tShankel M, Nelson TM, Quiros KAM, Bebawy J, Mariano CA, Biddle T, et al. Lung recruitment mechanics: coalescing tissue strains with organ expansion. Respir Res 2025;26:58. https:\/\/doi.org\/10.1186\/s12931-025-03118-8","DOI":"10.1186\/s12931-025-03118-8"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"4.\tDong Z, Liu Y, Gai Y, Meng P, Lin H, Zhao Y, et al., Early rehabilitation relieves diaphragm dysfunction induced by prolonged mechanical ventilation: a randomised control study. BMC Pulm Med 2021;21:106.  https:\/\/doi.org\/10.1186\/s12890-021-01461-2","DOI":"10.1186\/s12890-021-01461-2"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"5.\tvan Kaam AH. Optimal strategies of mechanical ventilation: can we avoid or reduce lung injury? Neonatology 2024;121:570-575. https:\/\/doi.org\/10.1159\/000539346","DOI":"10.1159\/000539346"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"6.\tSella N, Pettenuzzo T, Zarantonello F, Andreatta G, De Cassai A, Schiavolin C, et al. Electrical impedance tomography: A compass for the safe route to optimal PEEP. Respir Med 2021;187:106555. https:\/\/doi.org\/10.1016\/j.rmed.2021.106555","DOI":"10.1016\/j.rmed.2021.106555"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"7.\tMagalh\u00e3es PAF, Camillo CA, Langer D, Andrade LB, Duarte MDCMB, Gosselink R. Weaning failure and respiratory muscle function: What has been done and what can be improved? Respir Med 2018;134:54-61. https:\/\/doi.org\/10.1016\/j.rmed.2017.11.023","DOI":"10.1016\/j.rmed.2017.11.023"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"8.\tLee HY, Cho J, Kwak N, Choi SM, Lee J, Park YS, et al. Improved Oxygenation After Prone Positioning May Be a Predictor of Survival in Patients With Acute Respiratory Distress Syndrome. Crit Care Med 2020;48:1729-1736. https:\/\/doi.org\/10.1097\/CCM.0000000000004611","DOI":"10.1097\/CCM.0000000000004611"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"9.\tBenites MH, Zapata-Canivilo M, Poblete F, Labbe F, Battiato R, Ferre A, et al. Physiological and clinical effects of trunk inclination adjustment in patients with respiratory failure: a scoping review and narrative synthesis. Crit Care 2024;28:228. https:\/\/doi.org\/10.1186\/s13054-024-05010-1","DOI":"10.1186\/s13054-024-05010-1"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"10.\tJonkman AH, Alcala GC, Pavlovsky B, Roca O, Spadaro S, Scaramuzzo G, et al. Lung Recruitment Assessed by Electrical Impedance Tomography (RECRUIT): A multicenter study of COVID-19 acute respiratory distress syndrome. Am J Respir Crit Care Med 2023;208:25-38. https:\/\/doi.org\/10.1164\/rccm.202212-2300OC","DOI":"10.1164\/rccm.202212-2300OC"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"11.\tJimenez JV, Munroe E, Weirauch AJ, Fiorino K, Culter CA, Nelson K, et al. Electric impedance tomography-guided PEEP titration reduces mechanical power in ARDS: a randomized crossover pilot trial. Crit Care 2023;27:21. https:\/\/doi.org\/10.1186\/s13054-023-04315-x","DOI":"10.1186\/s13054-023-04315-x"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"12.\tRauseo M, Mirabella L, Laforgia D, Lamanna A, Vetuschi P, Soriano E, et al. A pilot study on electrical impedance tomography during CPAP trial in patients with severe acute respiratory syndrome coronavirus 2 pneumonia: The bright side of non-invasive ventilation. Front Physiol 2021;12:728243. https:\/\/doi.org\/10.3389\/fphys.2021.728243","DOI":"10.3389\/fphys.2021.728243"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"13.\tWang YX, Zhong M, Dong MH, Song JQ, Zheng YJ, Wu W, et al. Prone positioning improves ventilation-perfusion matching assessed by electrical impedance tomography in patients with ARDS: a prospective physiological study. Crit Care 2022;26:154. https:\/\/doi.org\/10.1186\/s13054-022-04021-0","DOI":"10.1186\/s13054-022-04021-0"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"14.\tBecher T, Buchholz V, Hassel D, Meinel T, Sch\u00e4dler D, Frerichs I, et al. Individualization of PEEP and tidal volume in ARDS patients with electrical impedance tomography: a pilot feasibility study. Ann Intensive Care 2021;11:89. https:\/\/doi.org\/10.1186\/s13613-021-00877-7","DOI":"10.1186\/s13613-021-00877-7"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"15.\tFranchineau G, Jonkman AH, Piquilloud L, Yoshida T, Costa E, Roz\u00e9 H, et al. Electrical impedance tomography to monitor hypoxemic respiratory failure. Am J Respir Crit Care Med 2024;209:670-682. https:\/\/doi.org\/10.1164\/rccm.202306-1118CI","DOI":"10.1164\/rccm.202306-1118CI"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"16.\tZhang YS, Zhang K, Huang L, Wei JX, Bi ZT, Xiao JH, et al. The effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke: a meta-analysis. Eur Rev Aging Phys Act 2024;21:4. https:\/\/doi.org\/10.1186\/s11556-024-00338-7","DOI":"10.1186\/s11556-024-00338-7"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"17.\tBissett B, Gosselink R, van Haren FMP. Respiratory muscle rehabilitation in patients with prolonged mechanical ventilation: a targeted approach. Crit Care 2020;24:103. https:\/\/doi.org\/10.1186\/s13054-020-2783-0","DOI":"10.1186\/s13054-020-2783-0"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"18.\tRos\u00e0 T, Menga LS, Mastropietro C, Settanni D, Russo A, Frassanito L, et al. Evaluation of the potential for lung recruitment with the recruitment-to-inflation ratio during general anesthesia. Anesthesiology 2025;143:1211-1224. https:\/\/doi.org\/10.1097\/ALN.0000000000005677","DOI":"10.1097\/ALN.0000000000005677"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"19.\tChidini G, Marchesi T, Catenacci SS, Florio G, Conti G, Lanni S, et al. 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;35:562-572. https:\/\/doi.org\/10.1111\/pan.15098","DOI":"10.1111\/pan.15098"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"20.\tScaramuzzo G, Priani P, Ferrara P, Verri M, Montanaro F, La Rosa R, et al. Longitudinal changes of electrical impedance tomography-based best PEEP in obese patients undergoing laparoscopic surgery: A prospective physiological study. Anaesth Crit Care Pain Med 2025;44:101569. https:\/\/doi.org\/10.1016\/j.accpm.2025.101569","DOI":"10.1016\/j.accpm.2025.101569"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"21.\tXin Y, Martin K, Morais CCA, Delvecchio P, Gerard SE, Hamedani H, et al. Diminishing efficacy of prone positioning with late application in evolving lung injury. Crit Care Med 2021;49:e1015-e1024. https:\/\/doi.org\/10.1097\/CCM.0000000000005071","DOI":"10.1097\/CCM.0000000000005071"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"22.\tZeng C, Zhu M, Motta-Ribeiro G, Lagier D, Hinoshita T, Zang M, et al. Dynamic lung aeration and strain with positive end-expiratory pressure individualized to maximal compliance versus ARDSNet low-stretch strategy: a study in a surfactant depletion model of lung injury. Crit Care 2023;27:307. https:\/\/doi.org\/10.1186\/s13054-023-04591-7","DOI":"10.1186\/s13054-023-04591-7"}],"container-title":["Physiological Research"],"original-title":[],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T19:46:10Z","timestamp":1788810370000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.biomed.cas.cz\/physiolres\/pdf\/2026\/75_759.pdf"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":22,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,8,31]]}},"URL":"https:\/\/doi.org\/10.33549\/physiolres.935744","relation":{},"ISSN":["1802-9973"],"issn-type":[{"value":"1802-9973","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]}}}