CoRLEIT, Covid Regional Lung EIT

COVID-19大流行面临的一项关键挑战是需要监测病情恶化情况，并为数量空前的有呼吸衰竭风险的患者及时提供升级干预措施。现有监测难以预测covid -19肺炎的突然恶化。目前来自CT扫描的区域信息是信息性的（Scudellari, 2020），但不提供动态信息。迫切需要一种低成本、床边、无创的影像系统，持续监测局部肺通气[2][3][4][5]的动态变化。电阻抗断层扫描（EIT）可以提供这一点，并已被证明在治疗婴儿和成人的急性呼吸综合征方面很有用（Bachmann et al 2018）。我们已经为新生儿开发了低成本的可穿戴EIT系统（CRADL; http://cradlproject.org/），并获得了200名受试者的临床结果，每个受试者连续监测颞肺容量变化长达72小时。这项技术可以重新用于COVID-19患者（附录），旨在为COVID-19病理生理学提供新的见解，并有可能为大规模呼吸衰竭监测提供解决方案。在重症监护室前患者中使用EIT，评估和分层治疗反应（俯卧位，CPAP，其他呼吸支持），然后在病情恶化时进行通气干预，将为COVID-19如何影响呼吸系统提供宝贵的信息。这将确立EIT监测COVID-19呼吸衰竭的优点，特别是加强和加快对COVID-19最佳呼吸支持治疗策略的临床研究，并促进EIT指导的个性化治疗方案的制定。

A key challenge for the COVID-19 pandemic is the requirement to monitor for deterioration and provide timely escalation interventions to an unprecedented number of patients at risk of respiratory failure. Existing monitoring poorly predicts sudden deterioration in COVID-19pneumonia. Regional information, currently from CT scans, has been informative (Scudellari, 2020) [1], but does not provide dynamic information. There is an urgent need for a low cost, bedside,non-invasive imaging system, to continuously monitor dynamic changes in regional lung ventilation [2][3][4][5].Electrical Impedance Tomography (EIT) can provide this and has proved useful in managing acute respiratory syndrome in infants and adults (Bachmann et al 2018) [2]. We have already developeda low cost wearable EIT system for neonates (CRADL; http://cradlproject.org/) and obtainedclinical results from 200 subjects, each for up to 72 hours of continuous monitoring of temporal lung volume changes.This technology can be repurposed for COVID-19 patients (Appendix) with the aim of providing novel insights into COVID-19 pathophysiology, and with the potential to provide a solution for respiratory failure monitoring at scale. Using EIT in HDU-pre-ICU patients, evaluating and stratifying treatment response (to prone positioning, CPAP, other breathing support) and thenfollowing through into ICU with ventilation interventions if they deteriorate, will add invaluable information about how COVID-19 effects the respiratory system. This will establish the merits of EIT monitoring for COVID-19 respiratory failure, in particular enhance and expedite clinical research into optimal COVID-19 breathing support treatment strategy and facilitate development of EIT guided personalised treatment plans.