Respiratory Monitoring with PulmoVista 500 - Respiratory Monitoring with PulmoVista 500 — Respiratory Monitoring with PulmoVista 500
Contact Us

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)

Device handling, application tips and examples

Download

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 paediatric 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

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.

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.

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.

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.:

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)

Download

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.

Download infographic

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.

Decision Drivers for PulmoVista 500

Learn why the Canadian ventilation expert have chosen PulmoVista 500:

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:

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:

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:

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:

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:

PulmoVista® 500 in everyday clinical routine

Download

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?

Download

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.
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
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.
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
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
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
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.