Chest physiotherapy guided by electrical impedance tomography in patients with pneumonia: a pilot randomized-controlled trial

This study aimed to investigate the effectiveness of chest physiotherapy (CPT) guided by electrical impedance tomography (EIT) in patients with pneumonia, compared to conventional CPT. Patients with community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP) were randomly assigned to an EIT-guided chest physiotherapy (EIT-guided) group or a control group. Both groups received standard pneumonia treatment. The conventional CPT protocol was determined after evaluation. The EIT-guided group received CPT guided by EIT real-time ventilation distribution in addition to conventional CPT. Each group underwent two CPT sessions per day (20 min in both morning and afternoon). The primary endpoint was the time to clinical improvement, defined as the earliest of four prospectively predefined follow-up assessments (baseline, day 3, day 5, and day 7) at which a reduction in the Clinical Pulmonary Infection Score (CPIS) relative to baseline was observed. As CPIS was assessed at scheduled visits rather than continuously, the time to improvement corresponds to the first such visit demonstrating a lower CPIS, rather than to a continuous daily observation. The secondary outcomes were length of hospitalization, costs of hospitalization and degree of patient satisfaction with CPT. A total of 307 patients were screened and 185 were randomized ( n = 92 vs. 93, control vs. EIT-guided groups). Compared with the control group, the EIT-guided group showed earlier improvement in CPIS, a significantly lower CPIS: 5 (4, 6) vs. 4 (3, 4) and 2 (2, 3) vs. 0 (0, 2) on the fifth and seventh days of treatment ( p < 0.001; control vs. EIT-guided groups). Patients in the EIT-guided group had a shorter hospital stay (9.4 ± 1.1 days vs. 8.4 ± 1.5 days, p < 0.001; control vs. EIT-guided groups), lower hospitalization costs (CNY 20821.50 ± 2391.27 vs. CNY 19181.27 ± 2460.11, p < 0.001), and higher patient satisfaction with CPT (satisfaction score 18 (14, 21) vs. 24 (19, 25), p < 0.001). Compared to conventional CPT, EIT-guided CPT provides real-time visual feedback, enabling physiotherapists to develop individualized CPT plans. This approach improves treatment outcomes, reduces hospital stay and medical costs, and increases patient satisfaction. Chinese Clinical Trial Registry, ChiCTR2000033373. Registered 21 May 2020, https://www.chictr.org.cn.