Use of the Electrical Impedance Segmentography system in a neonatal respiratory distress case

Introduction: The Electrical Impedance Segmentography system (EIS) is a technique able to detect any kind of dishomogeneities between the pulmonary segments and to study the air distribution and the regional current volumes, by monitoring the impedance in the four pulmonary quadrants, in a continuous, non-invasive, fast and low-cost manner. We used this method for the management of a patient born at term with respiratory distress. Case Report: On admission to the ward, a noninvasive respiratory assistance was set up. The chest X-ray showed a massive opacity of the left hemithorax as due to a pulmonary atelectasis. Therefore, we decided to administer surfactant by the ET tube using the INSURE technique, with a slight, clinical and radiological improvement. At the same time, we started to monitor our patient ventilation using the EIS: in agreement with the radiological findings, it revealed an initial exclusion of the left, lower, pulmonary lobe and a progressive lung recruitment. It also showed immediate changes of the EIS patterns after every therapeutic maneuver (airway aspiration, surfactant administration, PEEP variations). On the 10th day of life a clinical stabilization and a complete radiological resolution were achieved, so the baby was weaned from the respiratory assistance. Conclusion: The presented case, in agreement with the literature, shows that the EIS can represent a safe and effective guide to set up the mechanical ventilation in newborns. In fact, it supplies a non-invasive and immediate assessment of ventilation, highlighting the poor ventilated areas and allowing immediate therapeutic adjustments.