Tomografia de impedância elétrica e sua aplicabilidade em unidades de terapia intensiva neonatal: revisão de escopo

Abstract

Introduction: Advances in neonatal intensive care have increased the survival of newborns—particularly extremely preterm infants—while simultaneously raising the incidence of respiratory morbidities and the need for individualized ventilation strategies. In this context, monitoring respiratory mechanics is crucial for optimizing mechanical ventilation and minimizing ventilator-associated lung injury in neonates admitted to intensive care units (ICUs). Although effective, traditional technologies may have limitations regarding the early detection of pulmonary complications and the personalization of ventilatory support. Consequently, various emerging technologies have been developed to enhance this monitoring. Electrical impedance tomography (EIT) has emerged as a promising tool, offering real-time, non-invasive, and radiation-free imaging that enables the dynamic adjustment of ventilatory parameters. Despite technical and operational limitations, its use in neonatology is expanding due to its potential to improve the safety and efficacy of respiratory management. Therefore, this study aims to map and analyze scientific evidence regarding the applicability of EIT in neonates admitted to NICUs, identifying the most commonly used EIT functional parameters, the adverse effects and benefits of EIT use, and its contributions. Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) guidelines, the PRISMA-ScR checklist, and the published protocol. Searches were performed in the PubMed, Embase, CINAHL, Web of Science, and Cochrane Library databases. Clinical and observational studies evaluating the use of EIT in neonates in NICUs—published in English, Spanish, or Portuguese, with no date restrictions—were eligible for inclusion. Two independent reviewers performed study screening, selection, and data extraction, with a third reviewer resolving any conflicts. Data were extracted, descriptively synthesized, and categorized according to the review questions. Although not a requirement for a scoping review, an assessment of the methodological quality of the included studies was conducted to support the interpretation of findings and contextualize the robustness of the evidence. Results: Nineteen studies—predominantly observational—were included, investigating the use of EIT in neonates admitted to ICUs requiring respiratory support. EIT was primarily used to assess regional ventilation distribution and monitor lung volume, track the impact of interventions on lung aeration, and optimize ventilator settings in critically ill neonates. Changes in impedance and expiratory lung volume were the main parameters evaluated by EIT in the neonatal population. Final considerations: Overall, the studies highlighted the potential of EIT as a tool for the dynamic, non-invasive, bedside assessment of lung function. Compared to traditional methods, EIT offers a real-time, regional assessment of pulmonary ventilation, overcoming the limitations of static approaches based on global measurements. However, transitioning EIT from research to routine clinical practice in neonatal ICUs depends on overcoming methodological and structural barriers, such as limited spatial resolution, high costs, and the need for specialized staff training. Added to this are the absence of standardized reference values for the neonatal population and the lack of consensus among centers regarding image acquisition and interpretation protocols, which hinders the comparison of results and large-scale validation.