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Background  The electrical impedance tomography (EIT)-based global inhomogeneity (GI) index was introduced to quantify tidal volume distribution within the lung. Up to now, the GI index was evaluated for plausibility but the analysis of how it is influenced by various physiological factors is still missing. The aim of our study was to evaluate the influence of proportion of open lung regions measured by EIT on the GI index.    Methods  A constant low-flow inflation maneuver was performed in 18 acute respiratory distress syndrome (ARDS) patients (58 ± 14 years, mean age ± SD) and 8 lung-healthy patients (41 ± 12 years) under controlled mechanical ventilation. EIT raw data were acquired at 25 scans/s and reconstructed offline. Recruited lung regions were identified as those image pixels of the lung regions within the EIT scans where local impedance amplitudes exceeded 10% of the maximum amplitude during the maneuver. A series of GI indices was calculated during mechanical lung inflation, based on the differential images obtained between different time points. Respiratory system elastance (E rs ) values were calculated at 10 lung volume levels during low-flow maneuver.    Results  The GI index decreased during low-flow inflation, while the percentage of open lung regions increased. The values correlated highly in both ARDS (r 2  = 0.88 ± 0.08, p < 0.01) and lung-healthy patients (r 2  = 0.92 ± 0.05, p < 0.01). E rs  and GI index were also significantly correlated in 16 out of 18 ARDS (r 2  = 0.84 ± 0.13, p < 0.01) and in 6 out of 8 lung-healthy patients (r 2  = 0.84 ± 0.07, p < 0.01). Significant differences were found in GI values between two groups (0.52 ± 0.21 for ARDS and 0.41 ± 0.04 for lung-healthy patients,  p <  0.05) as well in E rs  values (0.017 ± 0.008 cmH 2 O/ml for ARDS and 0.009 ± 0.001 cmH 2 O/ml for lung-healthy patients,  p <  0.01).    Conclusions  We conclude that the GI index is a reliable measure of ventilation heterogeneity highly correlated with lung recruitability measured with EIT. The GI index may prove to be a useful EIT-based index to guide ventilation therapy.

The EIT-based global inhomogeneity index is highly correlated with regional lung opening in patients with acute respiratory distress syndrome