Electrical Impedance Tomography in Pediatric Acute Respiratory Distress Syndrome: Dynamic Ventilation Monitoring and Clinical Correlation Analysis from Intubation to Extubation

Objective: This study aims to investigate the dynamic evolution patterns of regional ventilation parameters monitored by bedside electrical impedance tomography (EIT) in pediatric patients with acute respiratory distress syndrome (ARDS) from endotracheal intubation to planned extubation, to analyze their correlation with traditional disease severity classification, and to evaluate their predictive value for extubation outcomes. Methods: This study employed a retrospective single-center cohort design. Pediatric ARDS patients who received invasive mechanical ventilation and underwent EIT monitoring in our hospital's PICU from January 2023 to September 2025 were included. Baseline patient data, ARDS etiology (pneumonia-associated or non-pneumonia-associated), and disease severity (based on the oxygenation index) were collected. EIT parameters, including the center of ventilation, global inhomogeneity index, and regional ventilation delay index and ratio, were recorded during the stable post-intubation period (T1) and prior to planned extubation (T2). The primary outcome was reintubation within 72 hours after extubation. Paired sample tests were used to compare differences in parameters between T1 and T2. Spearman correlation analysis was employed to assess the correlation between T1 parameters and disease severity, and independent sample tests along with receiver operating characteristic curve analysis were used to evaluate the predictive efficacy of T2 parameters for extubation failure. Results : A total of 42 pediatric patients were included, with a median age of 4.6 years. Pneumonia-associated ARDS accounted for 85.7% (36/42) of cases, and extubation failure occurred in 4 patients (9.5%). Compared to T1, both the global inhomogeneity index (GI) and regional ventilation delay parameters showed significant improvement at T2 (all P < 0.01), while the center of ventilation and regional distribution proportions exhibited no significant change. No significant correlation was found between EIT parameters at intubation and traditional ARDS severity grading (all P > 0.05). Although no statistically significant differences in pre-extubation EIT parameters were observed between the successful and failed extubation groups (all P > 0.05), strong internal consistency was noted among the EIT parameters. For example, a significant positive correlation was identified between the GI and the regional ventilation delay ratio (rs = 0.609, P < 0.001). Conclusion: During the treatment of pediatric ARDS, EIT can non-invasively and dynamically monitor significant improvements in the homogeneity and synchrony of pulmonary ventilation, providing objective bedside physiological evidence for the recovery of lung function. However, this study found that pre-extubation regional ventilation parameters failed to independently predict extubation outcomes and showed no significant correlation with severity grading based on the traditional oxygenation index. This suggests that in the clinical management of pediatric ARDS, the core value of EIT may lie more in its real-time visual guidance for optimizing lung-protective ventilation strategies, rather than serving as a standalone tool for severity classification or weaning prediction. Future studies with larger sample sizes are needed to investigate the potential role of EIT in integrated physiological monitoring and personalized therapeutic decision support.