{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:16:07Z","timestamp":1788498967819,"version":"build-2803163510"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bronchoalveolar lavage (BAL) may cause regional lung derecruitment during bronchoscopy. However, this effect may be underestimated by conventional oxygenation monitoring, especially under general anesthesia and mechanical ventilation. This study aimed to assess BAL-associated lung derecruitment using electrical impedance tomography (EIT) and to explore related clinical, radiological, and physiological factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective observational study included adult patients who underwent BAL with periprocedural EIT monitoring between March 2024 and October 2025. EIT data were analyzed at three time points: before BAL, immediately after BAL, and after completion of the procedure. The primary outcome was residual end-expiratory lung impedance loss after BAL. Secondary outcomes included changes in defect score, global inhomogeneity index, center of ventilation, regional ventilation delay, respiratory mechanics, and oxygen saturation. Linear regression was used to identify factors associated with residual EELI loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 405 screened patients, 286 met the inclusion criteria, and 277 were finally analyzed. BAL was associated with a significant decrease in EELI and increases in defect score and global inhomogeneity index, indicating lung derecruitment and more heterogeneous ventilation distribution. Driving pressure increased and dynamic compliance decreased after BAL, while SpO\n                      <jats:sub>2<\/jats:sub>\n                      showed no significant change. In multivariable analysis, preoperative atelectasis was independently associated with greater residual EELI loss, with an adjusted \u03b2 coefficient of 1.71 (95% CI 0.41\u20133.00, P\u00a0=\u00a00.010). Baseline defect score was also independently associated with residual EELI loss, with an adjusted \u03b2 coefficient of 0.51 (95% CI 0.07\u20130.95, P\u00a0=\u00a00.025). In contrast, total BAL instilled volume, number of BAL cycles, and bronchoscope insertion duration were not significantly associated with residual EELI loss.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      BAL was associated with immediate lung derecruitment and worsening of regional ventilation distribution under general anesthesia and mechanical ventilation, despite stable SpO\n                      <jats:sub>2<\/jats:sub>\n                      . Preoperative atelectasis and baseline regional ventilation defects were independently related to incomplete lung volume recovery after BAL. EIT may help identify patients at higher risk of BAL-associated lung derecruitment and support individualized respiratory management during bronchoscopy.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphys.2026.1900825","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:26:34Z","timestamp":1788495994000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Electrical impedance tomography assessment of bronchoalveolar lavage-associated lung derecruitment and its related factors: a single-center retrospective study"],"prefix":"10.3389","volume":"17","author":[{"given":"Aijie","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]},{"name":"Department of Anesthesiology, Xi\u2019an Hospital of Traditional Chinese Medicine","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanqi","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Shen","sequence":"additional","affiliation":[{"name":"School of Public Health, Health Science Centre of Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhua","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Imaging, Xi\u2019an Hospital of Traditional Chinese Medicine","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Guan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kailu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, The Fourth Military Medical University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1186\/s13054-025-05727-7","article-title":"Association between controlled mechanical ventilation and systemic inflammation in acute hypoxemic respiratory failure: an observational cohort study","volume":"29","author":"Bachmann","year":"2025","journal-title":"Crit. Care"},{"key":"B2","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s13613-025-01526-z","article-title":"Lung electrical impedance tomography during positioning, weaning and chest physiotherapy in mechanically ventilated critically ill patients: a narrative review","volume":"15","author":"Bayat","year":"2025","journal-title":"Ann. Intensive Care"},{"key":"B3","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1097\/mcc.0000000000000692","article-title":"Lung protection in acute respiratory distress syndrome: what should we target","volume":"26","author":"Beitler","year":"2020","journal-title":"Curr. Opin. Crit. Care"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1590\/1806-9282.20251019","article-title":"The role of electrical impedance tomography in intensive care units: applications and clinical perspectives","volume":"72","author":"Bilir","year":"2026","journal-title":"Rev. da Associa\u00e7\u00e3o M\u00e9dica Bras."},{"key":"B5","doi-asserted-by":"publisher","first-page":"9773","DOI":"10.1038\/s41598-025-91217-3","article-title":"Lung recruitment state during induction of general anaesthesia in a prospective observational clinical study in patients without and with obesity","volume":"15","author":"Borgmann","year":"2025","journal-title":"Sci. Rep."},{"key":"B6","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s44158-026-00363-1","article-title":"Characterization of lung microbiota in pneumonia: a pilot study in ICU and non-ICU patients","volume":"6","author":"Bruni","year":"2026","journal-title":"J. Anesthesia Analgesia Crit. Care"},{"key":"B7","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1007\/s12630-018-1121-3","article-title":"Anesthesia for interventional pulmonology procedures: a review of advanced diagnostic and therapeutic bronchoscopy","volume":"65","author":"de Lima","year":"2018","journal-title":"Can. J. Anaesth."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e231","DOI":"10.1097\/ccm.0000000000005302","article-title":"Electrical impedance tomography monitoring of bronchoalveolar lavage in patients with acute respiratory distress syndrome","volume":"50","author":"Franchineau","year":"2021","journal-title":"Crit. Care Med."},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1186\/s40635-019-0225-6","article-title":"Regional pulmonary effects of bronchoalveolar lavage procedure determined by electrical impedance tomography","volume":"7","author":"Frerichs","year":"2019","journal-title":"Intensive Care Med. Exp."},{"key":"B10","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1111\/j.1399-6576.1998.tb05308.x","article-title":"Monitoring perioperative changes in distribution of pulmonary ventilation by functional electrical impedance tomography","volume":"42","author":"Frerichs","year":"2008","journal-title":"Acta Anaesthesiologica Scandinavica"},{"key":"B11","doi-asserted-by":"publisher","first-page":"075005","DOI":"10.1088\/1361-6579\/ad5ef7","article-title":"Sex differences in chest electrical impedance tomography findings","volume":"45","author":"Frerichs","year":"2024","journal-title":"Physiol. Meas."},{"key":"B12","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1164\/rccm.201908-1502le","article-title":"Simple electrical impedance tomography measures for the assessment of ventilation distribution","volume":"201","author":"Frerichs","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"085008","DOI":"10.1088\/1361-6579\/abab1b","article-title":"Monitoring bronchoalveolar lavage with electrical impedance tomography: first experience in a patient with COVID-19","volume":"41","author":"Fu","year":"2020","journal-title":"Physiol. Meas."},{"key":"B14","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1159\/000534149","article-title":"Deep learning neural network-guided detection of asbestos bodies in bronchoalveolar lavage samples","volume":"67","author":"Hakkarainen","year":"2023","journal-title":"Acta Cytologica"},{"key":"B15","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1186\/s13613-021-00921-6","article-title":"Three broad classifications of acute respiratory failure etiologies based on regional ventilation and perfusion by electrical impedance tomography: a hypothesis-generating study","volume":"11","author":"He","year":"2021","journal-title":"Ann. Intensive Care"},{"key":"B16","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s00134-002-1555-4","article-title":"End-expiratory lung impedance change enables bedside monitoring of end-expiratory lung volume change","volume":"29","author":"Hinz","year":"2003","journal-title":"Intensive Care Med."},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000003400","article-title":"Exercise-induced changes in exhaled NO differentiates asthma with or without fixed airway obstruction from COPD with dynamic hyperinflation","volume":"95","author":"Huang","year":"2016","journal-title":"Medicine"},{"key":"B18","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1007\/s12519-025-00967-7","article-title":"Advances in pediatric flexible bronchoscopy","volume":"21","author":"Li","year":"2025","journal-title":"World J. Pediatr."},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1097\/cce.0000000000000486","article-title":"Personalized positive end-expiratory pressure and tidal volume in acute respiratory distress syndrome: bedside physiology-based approach","volume":"3","author":"Mauri","year":"2021","journal-title":"Crit. Care Explor."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8081161","article-title":"A modified method to assess tidal recruitment by electrical impedance tomography","volume":"8","author":"Muders","year":"2019","journal-title":"J. Clin. Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"491","DOI":"10.2147\/jaa.s497218","article-title":"Peripheral airway obstruction in association with symptoms and quality of life in asthma","volume":"18","author":"Papapostolou","year":"2025","journal-title":"J. Asthma Allergy"},{"key":"B22","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1186\/s12890-021-01584-6","article-title":"Anesthesia considerations to reduce motion and atelectasis during advanced guided bronchoscopy","volume":"21","author":"Pritchett","year":"2021","journal-title":"BMC Pulmonary Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1186\/s13054-024-05173-x","article-title":"Electrical impedance tomography monitoring in adult ICU patients: state-of-the-art, recommendations for standardized acquisition, processing, and clinical use, and future directions","volume":"28","author":"Scaramuzzo","year":"2024","journal-title":"Crit. Care"},{"key":"B24","doi-asserted-by":"publisher","first-page":"2401603","DOI":"10.1183\/13993003.01603-2024","article-title":"GOLD Science Committee recommendations for the use of pre- and post-bronchodilator spirometry for the diagnosis of COPD","volume":"65","author":"Singh","year":"2025","journal-title":"Eur. Respir. J."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23010047","article-title":"Myeloid ABCG1 deficiency enhances apoptosis and initiates efferocytosis in bronchoalveolar lavage cells of murine multi-walled carbon nanotube-induced granuloma model","volume":"23","author":"Soliman","year":"2021","journal-title":"Int. J. Mol. Sci."},{"key":"B26","doi-asserted-by":"publisher","first-page":"108754","DOI":"10.1186\/s12931-026-03514-8","article-title":"EIT-based ventilation phenotypes of left-to-right asymmetry and ventral-to-dorsal center in PEEP titration in ARDS","volume":"27","author":"Sun","year":"2026","journal-title":"Respir. Res."},{"key":"B27","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1097\/ccm.0b013e3181652edd","article-title":"Electrical impedance tomography compared with thoracic computed tomography during a slow inflation maneuver in experimental models of lung injury","volume":"36","author":"Wrigge","year":"2008","journal-title":"Crit. Care Med."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2026.108754","article-title":"Bronchoalveolar lavage combined with electrical impedance tomography in the treatment of very elderly patients with severe pneumonia: a prospective study","volume":"255","author":"Xiong","year":"2026","journal-title":"Respir. Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1007\/s10877-022-00935-w","article-title":"Bedside electrical impedance tomography in early diagnosis of pneumothorax in mechanically ventilated ICU patients \u2014 a single-center retrospective cohort study","volume":"37","author":"Yang","year":"2023","journal-title":"J. Clin. Monit. Comput."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1900","DOI":"10.1007\/s00134-009-1589-y","article-title":"Evaluation of an electrical impedance tomography-based global inhomogeneity index for pulmonary ventilation distribution","volume":"35","author":"Zhao","year":"2009","journal-title":"Intensive Care Med."}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1900825\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:26:35Z","timestamp":1788495995000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1900825\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":30,"alternative-id":["10.3389\/fphys.2026.1900825"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2026.1900825","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]},"article-number":"1900825"}}