CoRLEIT, Covid Regional Lung EIT

COVID-19大流行的一个关键挑战是需要监测病情恶化，并为前所未有数量的呼吸衰竭风险患者提供及时的升级干预措施。现有监测难以预测COVID-19肺炎的突然恶化。目前来自CT扫描的区域信息是有用的（Scudellari，2020）[1]，但不能提供动态信息。迫切需要一种低成本、床旁、无创成像系统，以持续监测局部肺通气的动态变化[2][3][4][5]。电阻抗断层扫描（EIT）可以提供这一点，并已证明可用于管理婴儿和成人的急性呼吸综合征（Bachmann等人，2018）[2]。我们已经开发了一种低成本的新生儿可穿戴EIT系统（CRADL; http：//cradlproject.org/），并从200名受试者中获得了临床结果，每个受试者可持续监测长达72小时的临时肺体积变化。该技术可用于COVID-19患者（附录），旨在为COVID-19病理生理学提供新的见解，并有可能为呼吸衰竭监测提供大规模的解决方案。在HDU-前ICU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ICU通气干预，将增加关于COVID-19如何影响呼吸系统的宝贵信息。这将确立EIT监测COVID-19呼吸衰竭的优点，尤其是加强和加快临床研究，以获得最佳COVID-19呼吸支持治疗策略，并促进制定EIT指导的个性化治疗计划。

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.