Association of right ventricular dysfunction on electrocardiogram with outcomes and ventilatory response in patients monitored by electrical impedance tomography: A cohort study

Background: Mechanical ventilation is essential in critical care but can cause lung injury and hemodynamic compromise, particularly in patients with right ventricular dysfunction (RVD). Electrical impedance tomography (EIT) is increasingly used to guide ventilation, but its role in patients with RVD is not well defined. Objectives: To evaluate how electrocardiographic (ECG) signs of RVD influence the application and effects of EIT-guided ventilation management. Methods: This retrospective cohort study (2013–2023) included mechanically ventilated patients who underwent both ECG and EIT. Patients were grouped according to the presence of ECG signs of RVD. Demographic, clinical, and respiratory characteristics were compared. Airway pressures during EIT-guided recruitment maneuvers (RMs) and decremental positive end-expiratory pressure (PEEP) trials were analyzed using linear regression. Repeated ECG and EIT data were assessed using linear mixed-effects models. Results: Of 285 patients, 38 (13 %) had ECG signs of RVD. They were more often male (89.5 % vs. 74.1 %, p = 0.04), older (68.2 vs. 63.5 years, p = 0.02), and had higher mortality (65.8 % vs. 48.6 %, p < 0.05). During EIT-guided RMs, they received lower maximum PEEP (–2.2 to –0.4 cmH₂O) and a narrower decremental PEEP range (–2.5 to –0.9 cmH₂O, both p < 0.01). After EIT-guided optimization, dynamic compliance was higher in patients with ECG signs of RVD (43.6 vs. 38.4 mL/cmH₂O, p = 0.04). Conclusion: ECG signs of RVD identified a high-risk group that appeared less tolerant of, yet more responsive to, EIT-guided PEEP titration. By integrating respiratory and cardiac monitoring, EIT may facilitate safer ventilation strategies.