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Respiratory Monitoring with PulmoVista 500 - Respiratory Monitoring with PulmoVista 500

Respiratory Monitoring with PulmoVista 500

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PulmoVista 500, the electrical impedance tomography (EIT) system from Dräger, visualises respiratory functions directly at the patient's bedside, providing continuous, regional information about the distribution of ventilation in the lungs. This opens up the option for completely new ventilation strategies for you as an intensive care specialist. Using the EIT pulmonary monitor, you can individually adjust ventilation parameters and therapeutic measures to meet the patient's needs, resulting in a more protective ventilation. As such, PulmoVista 500 can contribute to a significant reduction in ventilator-associated lung injuries.

PulmoVista 500 Basics

Get a live report out of the lung! Pulmonary monitoring with PulmoVista 500.

How to get a live report out of the lung

How can you see signs of VILI in real-time and maybe avoid ARDS? Watch the video and see how the PulmoVista 500 can help you to find the right respiratory therapy for your patient.

Learn about pulmonary monitoring in 150 seconds

Bedside respiratory monitoring: PulmoVista 500

PulmoVista at a glance

Download our summary here

Constantin JM et al., 2019


“Personalisation of mechanical ventilation did not decrease mortality in patients with ARDS, possibly because of the misclassification of 21% of patients. A ventilator strategy misaligned with lung morphology substantially increases mortality.” ¹

Bellani G, Teggia-Droghi M, 2020


“To detect pendelluft phenomena and some asynchronies advanced monitoring devices are needed, such as electrical impedance tomography, esophageal manometry and electrical activity of the diaphragm” ²

Bellani G et al., 2016


“Turning the patients to the prone position significantly reduced alveolar overdistension and collapse and increased recruitable lung volume” ³

PulmoVista 500 supports you in a number of clinical applications related to ventilation therapy. Thanks to real-time information about the regional distribution of ventilation in the lungs, you gain a reliable and always up-to-date basis for your therapy decision-making. Instead of drawing conclusions from global information, you can now use EIT monitoring to immediately and continuously assess whether a therapeutic intervention is resulting in the desired effect, and then individually adjust measures accordingly. As such, PulmoVista 500 serves as a valuable decision-making aid at any phase of respiratory therapy such as:

Intubation Support

PulmoVista 500 helps you recognise and correct improper placement of the tube during endotracheal intubation. On the monitor, you can clearly recognise that only one side of the lung is being ventilated, because the tube is inserted too deep.

Identifying recruitment potential

PulmoVista 500: Assessing the response to a recruitment maneuver

PulmoVista 500 makes it easier than ever to assess whether and to what extent a patient is responding to a recruitment manoeuvre. The comparison of EIT images before and during recruitment could for example show that dorsal regions which were previously largely closed have been successfully opened afterwards. The tidal images, as well as the differential images, support this interpretation.

PEEP titration: Preventing collapse

Identifying the onset of derecruitment during a decremental PEEP trial

Setting the right positive end-expiratory pressure (PEEP) is crucial to lung-protective ventilation. If the pressure is too low, it can result in a collapsed lung. Excessive pressure can cause alveolar overdistension. PulmoVista 500 helps you determine the optimal PEEP level for each individual patient.

PEEP titration: Overdistension

Effects of possible overdistension within such a PEEP trial

An increase in PEEP may lead to a reduction in ventilation in the independent, ventral region of the lung, which will be visible in the differential image. This suggests potential alveolar overdistension caused by an excessive PEEP level, as visible in the tidal image. The result is a reduction in regional compliance.

Patient positioning

PulmoVista 500 is also a vital tool for assessing how the patient's positioning affects ventilation. If the patient is responding for example well to prone positioning, the EIT images will show a clear enlargement of the ventilated regions of the lungs. The information this provides can help you decide whether repositioning the patient has achieved the desired effect and should thus be continued.

Bronchoscopy and lung suction

User Insight: Bronchoscopy with PulmoVista 500

During bronchoscopy, a "look inside the lungs" provides important information. This allows you to immediately recognise whether regions of the lungs are being recruited by the removal of mucus. Additionally, the device allows you to better asses de-recruitment caused by lung suction, and to continuously monitor the process of restoring lung volume.

Possible reduction in x-rays and CT scans

Depending on the hospital's protocol, CT and/or x-ray images of the chest are taken at various points throughout the course of treatment. If the patient's condition allows, it may be possible to use functional EIT imaging to conduct the periodic progress check instead. This could lead to a reduction in the number of x-rays and CT scans, thus exposing the patient to less radiation. Additionally, this can prevent or reduce transports of critical intensive care patient.

Get more information how to start with PulmoVista 500 and the clinical application opportunities in our Mini Manual

Electrical Impedance Tomography (EIT)

Electrical Impedance Tomography (EIT)

Device handling, application tips and examples

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Ventilation Main and Fullscreen view

Utilizing EIT technology PulmoVista 500 enables dynamic, regional and non-invasive pulmonary monitoring right at the patient's bedside. In a cross-sectional projection, the distribution of the tidal volumes in the thorax is shown in real-time. This illustration shows ventilated and non-ventilated areas of the lungs as well as their changes over time. 

To measure lung impedance, a patient interface is needed. It consists of an elastic silicone belt with sixteen integrated electrodes placed around the patient's chest. Reusable belts are available in nine sizes for adult and pediatric patients.

PulmoVista 500 provides up to fifty images per second which depict the breathing as if in an animated movie. The regional distribution of ventilation is made clear through colour-coding: from black (for no ventilation), to dark blue (for minimal ventilation), to white (for maximal ventilation).

Dräger PulmoVista® 500

Dräger PulmoVista® 500

Making ventilation visible. Put the power of Electrical Impedance Tomography (EIT) to work for you and your patients. With the PulmoVista® 500, you can visualise regional air distribution within the lungs – non-invasive, in real time and directly at

Product details

The ‘Diagnostic View‘ of the PulmoVista 500

Tutorial video about the new Diagnostic View of PulmoVista 500

How it works

Watch the video for a brief introduction on the preparation, operation and results of the PEEP trial analysis provided by the Diagnostic View.

Diagnostic View of the PulmoVista 500

Assessment of PEEP trials within seconds

The Diagnostic View is a convenient bedside tool which automatically assesses PEEP trials by pressing one single button. It detects PEEP trials in the trend data and directly displays and quantifies indicators of alveolar collapse, alveolar overdistension and tidal recruitment within one view.

Besides the PEEP trial analysis, the Recruitability Analysis allows the assessment of lung recruitability prior to recruitment maneuvers and the Customized analysis enables the evaluation of any other therapeutic interventions.

The PulmoVista 500 indicates compliance loss and regional ventilation delay

Compliance loss and regional ventilation delay

The Diagnostic View provides new parameters which are suitable for estimating alveolar overdistension and collapse. A loss of regional compliance towards higher PEEP levels „C loss HP“, orange indicates overdistension. In contrast, the loss of compliance towards lower PEEP levels „C loss LP“, white is typically caused by lung collapse.

Regional ventilation delay (RVD) is an index, which indicates an inhomogeneous filling of lung region during inspiration. Pixels with delayed inspiration – in comparison to the average – are marked with a yellow colour. 

The PulmoVista 500 enables regional ventilation delay analysis

Regional ventilation delay

In the Diagnostic View, touching a tidal image will open a new window with an RVD map where yellow colouring marks delayed regions and green colouring marks those regions which fill faster in comparison with the average. RVD may indicate cyclical opening and closing or regionally varying time constants.

Signs of cyclical opening and closing: 

  • Delayed regions are relatively small
  • Delayed regions are located between well ventilated and non-ventilated areas
  • The regional waveform (yellow) shows both late opening and early closing (E) relative to the global waveform (white)

Signs of large time constants: 

  • Delayed regions are relatively large
  • Delayed regions are not located in the dorsal part next to collapse
  • Both regional inspiration AND expiration is delayed

Esophageal Pressure Measurement and Transpulmonary Monitoring

Transpulmonary Pressure Monitoring by Dräger

For the best individual ventilation strategy, you need to have access to the full clinical picture which consists of various sources of information.

Watch the video and learn how you can come one step closer to this picture with the Dräger PressurePod and the monitoring of Transpulmonary Pressure.

An important part on the way to the best individual ventilation therapy is the correct estimation of lung elastance and thus discrimination of the lung and chest wall mechanics.

With the measurement of Airway and Esophageal Pressures the Transpulmonary Pressure can be calculated. Depending on the spontaneous breathing activities of your ventilated patients you will also be able to improve the evaluation of different clinical challenges, e.g.:

PTP view header

For patients without spontaneous breathing efforts:

  • tidal mechanical stress
  • alveolar collapse
  • the total mechanical stress the lung tissue is exposed to

For spontaneously breathing patients the esophageal pressure waveform allows detecting:

  • reverse triggering
  • respiratory drive
  • asynchronies
  • extubation readiness

Do you want to know more about publications for this clinical application?

Download here our Esophageal and Transpulmonary Pressure Literature List:

Literature List 2020: Esophageal and Transpulmonary Pressure (Pes / Ptp)

Literature List 2020

Esophageal and Transpulmonary Pressure (Pes / Ptp)

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Transpulmonary pressure monitoring

By connecting the PressurePod to PulmoVista you are able to measure and display:

  • Airway Pressure (Paw),
  • Esophageal Pressure (Pes),
  • Transpulmonary Pressure (Ptp) – calculated as the difference between Paw and Pes,
  • Gastric Pressure (Pga).

You can analyse the derived parameters like e.g. the transpulmonary driving pressure to assess the lung mechanics.

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Assessment of the Transpulmonary Pressure with the Dräger PressurePod

Assessment of the Transpulmonary Pressure

You want to bring the individualisation of your ventilation therapy to a next level with Esophageal Pressure measurement and Transpulmonary Pressure monitoring?

Learn more about the set-up and how to start with the Dräger PressurePod in our Tutorial Video.

Experiences and References

Electrical impedance technology (EIT) with PulmoVista 500 has become a part of everyday clinical work in many leading intensive care units around the world. Find out why users have chosen this innovative technology, and learn about their experiences. When should you use the PulmoVista 500? In which clinical scenarios is the device most advantageous? For which patients, lung conditions, or complications is EIT suitable? Does using EIT really make a difference? Find out the answers to all these questions below, from the people who work with PulmoVista 500 every day.

Prof.Kotani-ShowaUniversityHospital-4-3.png

Professor Toru Kotani

Department of Intensive Care Medicine, Showa University School of Medicine

The Intensive Care Department at Showa University Hospital has 38 beds in the Intensive Care Unit (ICU) and 16 beds in the High Care Unit (HCU). Treatment is provided 24 hours a day by a team of full-time doctors centered on intensive care specialists and a multidisciplinary team of nurses, pharmacists, clinical engineers, physical therapists, and registered dietitians. The remote ICU system also supports these ICUs and the 25 ICU beds of the regional base hospitals.

Please tell us how you started incorporating EIT into your clinical practice?

I have been involved in EIT prototype testing since around 2008. At that time, I was doing research on APRV and recruitment. Mechanical ventilation in patients with severe respiratory failure played a critical role because VV-ECMO was also not available in Japan. I had already realized the importance of ventilation homogeneity at that time. However, only a chest CT was available to know how the ventilators worked on the lungs, so evaluation by EIT was very attractive, and from the research results, I could feel that it was a revolution that could be used clinically. So I decided to adopt it.

In addition to information from conventional monitoring equipment (CT images, ventilators, patient monitors), what kind of impact has the information provided by EIT had on clinical practice?

Before EIT, we  only had global indicators. Trials of adjusting ventilator settings were not always reflected to the indicators. In severe ARDS cases in which APRV worked well and saved lives, settings were sometimes significantly different from the lung protective strategy recommended by ARDSnet. It was often difficult to explain its validity. However,  when we saw a ventilation distribution changed to  homogeneous on EIT with a dramatic improvement in the patient's condition, we understood what happened and realized the importance of ventilation distribution monitoring. EIT is the best tool for ventilatory adjustment because it allows repeated evaluation of regional ventilation distribution at the bedside. This is the greatest advantage that other devices do not have.

Has EIT revolutionized mechanical ventilation therapy?

I have experienced the benefits of EIT in a lot of severe cases. It is not an exaggeration to say that EIT saved lives. I also realized that homogeneity of ventilation distribution is an important element of a lung protection strategy and the need for individualization of mechanical ventilation.

What are your hopes for the spread of EIT in Japan in the future?

I wish that EIT used and analyzed correctly result in prevention of VILI. Clinicians rely too much on PaO2/FIO2 for respiratory assessment. And they seems not interested in other physiological changes. This is probably because too little information is available at the bedside. I hope that the information obtained from EIT will be the key to solving the "why" in the clinical setting.

User Insight: Decision Drivers for PulmoVista 500 - St.Joseph's Healthcare

Decision Drivers for PulmoVista 500

Learn why the Canadian ventilation expert have chosen PulmoVista 500:

User Insight: Working with PulmoVista 500 - St.Joseph's Healthcare

Working with PulmoVista 500 - St.Joseph's Healthcare

Through PulmoVista 500 we receive direct regional information. This helps us to decide how a patient needs to be treated to achieve optimal results.”, says the Respiratory Therapist Thomas Piraino – learn more about their daily clinical routine with EIT:

User Insight: Education with PulmoVista 500 - St.Joseph's Healthcare

Education with PulmoVista 500

The availability of ventilation distribution information in real-time offers in addition very good training and education opportunities. Find out how the Canadian team makes use of this:

User Insight: Decision Drivers for PulmoVista 500

Decision Drivers for PulmoVista 500

The better the monitoring of the ventilation apparatus, the better the outcome for the patient." According to Professor Sergio Pintaudi this is one reason to decide for EIT- learn more about their Decision Drivers:

User Insight: Working with PulmoVista 500

Working with PulmoVista 500

Regional pulmonary monitoring with PulmoVista 500 has become a permanent fixture of the therapeutic strategy at Garibaldi Hospital. Find out when and how:

User Insight: Bronchoscopy with PulmoVista 500

Bronchoscopy with PulmoVista 500

You want to know how PulmoVista can support during Bronchoscopy? Watch the video from Garibaldi Hospital Catania, Italy:

Get the full report about the application of regional function lung monitoring at Garibaldi here:

Customer reference: PulmoVista® 500 in everyday clinical routine

PulmoVista® 500 in everyday clinical routine

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Serge J.H. Heines

Serge J.H. Heines

Ventilation Practitioner at the Intensive Care Unit at
Maastricht University Medical Centre+

Serge Heines is using EIT in clinical practice since 2013 and has collected a lot of experiences with this technology and the interpretation of images, parameters and analysis directly at the bedside. Get more information in the following short interview:

What was your main reason for integrating an innovative technology like EIT into your daily work?

Serge Heines: Our intensive-care unit has 27 beds in total, as well as six more in the monitoring station. Because of our bed count, it's no wonder we often see patients with severe lung failure in our station. Finding the right ventilator settings for each individual patient is still one of the hardest part of working in this area. We believe using EIT can help find the right parameters to prevent lung injuries (VALI). Plus, by using EIT, we may also be able to reduce the duration of ventilation or improve treatment outcomes.

For which patients are you currently using PulmoVista 500?

In the past, we primarily used PulmoVista 500 for patients with acute respiratory distress syndrome (ARDS), or for one-sided lung problems like lobar pneumonia, as well as pulmonary contusions. But we also used it in cases where we just didn't know what was going on in the lungs. Recently, we've all started using EIT for patients with fewer complications, or patients in post-operative care.

What insights have you gained from using EIT compared with previous monitoring devices, and how has that influenced your therapeutic strategy?

The regional distribution of ventilation in the lungs, breath by breath, is the most important and interesting information PulmoVista 500 provides. You can also directly monitor the effects of changes in ventilator settings. Before we started using EIT, we based our ventilation therapy on global information which we obtained either directly from the ventilator, or through arterial blood gas analysis. Now, we can really see if we've achieved what we wanted to, or whether our ventilator settings have had the desired effect. For example, there were instances where we thought we were achieving recruitment, but, in reality, the specific regions of the lungs hadn't even been reached. Or the PEEP turned out to be too high or too low. But now, we have clear information about these regions.

Has PulmoVista 500 changed your ventilation therapy?

We let EIT guide us now whenever we change our settings on the ventilator. Only time will tell, of course, if this leads to better treatment outcomes, for example, higher quality of care, a reduction in treatment duration, or a lower mortality rate.

If you had to explain the advantages of this method to a colleague, how would you describe it in your own words?

PulmoVista 500 visualises the ventilation and the effects of ventilation settings on your patient. It's a very useful tool, not just for choosing the right PEEP settings, but also for preventing over-distension of the lungs. In addition to that, PulmoVista 500 is perfect for bedside teaching, to help explain the mechanics of ventilation and changes in the lungs.

These are exemplary reference clinics using PulmoVista and EIT for several years in their clinical routine:

St. Thomas‘ Hospital, London

United Kingdom

Universal Hospital Maastricht

Netherlands

Garibaldi Hospital Catania, Sicily

Italy

A.O. Universitaria di Napoli, Seconda Università di Napoli, Neaples

Italy

Hospital Universitario del Henares, Madrid

Spain

St. Josephs Healthcare, Hamilton (Ontario)

Canada

Zhongda Hospital, Southeast University, Nanjing

China

Universitätsklinikum Knappschaftskrankenhaus, Bochum

Germany

Clinical Evidence

Numerous scientific studies and case reports prove that electrical impedance tomography (EIT) strongly contributes to more individualised and protective ventilation for intensive care patients. An increasing number of respiratory specialists worldwide are using this innovative technology to great effect and sharing their experiences within the growing EIT community.

Improved outcome with PulmoVista

Dalla Corte F et al., 2020


“EIT enables dynamic bedside assessment of the physiologic effects of prone positioning and might support early recognition of ARDS patients more likely to benefit from prone positioning.” ⁴

Liu K et al., 2019


“PEEP values determined with EIT effectively improved oxygenation and lung mechanics.“ ⁵

Zhao Z et al., 2019


“… the EIT-guided PEEP titration may be associated with improved oxygenation, compliance, driving pressure, and weaning success rate.“ ⁶

Kotani T et al., 2016


PulmoVista 500 helps to reduce VILI. ⁷

Electrical impedance tomography: On its way to gold standard?

Electrical impedance tomography: On its way to gold standard?

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  1. Constantin JM et al.; Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial; Lancet Respir Med. 2019 Oct;7(10):870-880.
  2. Bellani G., Teggia-Droghi M.; Assessment of VILI Risk During Spontaneous Breathing and Assisted Mechanical Ventilation. In: Vincent JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2020. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham
  3. Bellani et al., ‘Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries’, JAMA, vol. 315, Feb. 2016.
  4. Dalla Corte et al.; Dynamic bedside assessment of the physiologic effects of prone position in acute respiratory distress syndrome patients by electrical impedance tomography; Minerva Anestesiol. 2020; 10.23736/S0375-9393.20.14130-0
  5. Liu et al.; PEEP guided by electrical impedance tomography during one-lung ventilation in elderly patients undergoing thoracoscopic surgery; Ann Transl Med 2019;7(23):757
  6. Zhao et al.; Positive end expiratory pressure titration with electrical impedance tomography and pressure–volume curve in severe acute respiratory distress syndrome; Ann. Intensive Care (2019) 9:7
  7. Kotani et al., ‘Electrical impedance tomography-guided prone positioning in a patient with acute cor pulmonale associated with severe acute respiratory distress syndrome’, J. Anesth., vol. 30, Feb. 2016.

Scientific publications on EIT

What's the latest news about electrical impedance tomography from scientific research in publications and studies? We constantly monitor numerous scientific sources and present you with the latest in EIT research.

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Literature List 2021
PDF 409 KB

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EIT-Literature-list-2020-9-11.JPG
Literature List 2020
PDF 673 KB

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EIT Literature List 2019
Literature List 2019
PDF 456 KB

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EIT Literature List 2018
Literature List 2018
PDF 409 KB

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EIT Booklet
EIT Booklet
PDF 5.57 MB

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Dräger PulmoVista® 500

Dräger PulmoVista® 500

Making ventilation visible. Put the power of Electrical Impedance Tomography (EIT) to work for you and your patients. With the PulmoVista® 500, you can visualise regional air distribution within the lungs – non-invasive, in real time and directly at

Product details

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Try the PulmoVista 500 now

We are pleased to offer you the PulmoVista 500 for a fixed trial period, so you can experience first-hand the clinical benefits of EIT pulmonary monitoring.

Test the PulmoVista 500 today!

Would you like to test the PulmoVista 500 in your hospital environment? Contact us by completing the form below:

Nurse checks on patient’s medical ventilator in ICU

Medical Ventilators and Lung Monitoring

Visualising the effects of mechanical ventilation with the Evita® V800 and the PulmoVista® 500

Image-guided Lung Protection

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