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Electrical impedance tomography (EIT) produces lung ventilation images via a thoracic electrode belt. Robust electrode design and material, providing low electrode skin contact impedance (SCI), is needed in veterinary medicine. The aim of this study was to compare three EIT electrode designs and materials.Simulations of cylindrical, rectangular and spiked electrode designs were used to evaluate electrode SCI as a function of electrode size, where skin contact was uneven. Gold-plated washers (ESimulations that involved electrodes with a greater skin contact area had lower and more uniform SCI. In cattle, SCI decreased with all electrodes over time (p0.01). Without gel, no difference was found between ELow numbers of animals and static electrode position may affect SCI.Electrode design is important for EIT measurement, with larger electrode designs able to compensate for the use of less conductive materials. Gel is not necessary to achieve acceptable SCI in large animals.

Controlled mechanical ventilation (CMV) is routinely used in equine anaesthesia, with many different options available to facilitate the delivery of mechanical breaths. The complexity of equine respiratory pathophysiology and the wide range of devices available is described in the two parts of this scoping review. The second part of this review provides an overview of commercially available and hand-made devices that can be used to deliver CMV in large animals. A short overview of basic physics for mechanical ventilation is given. Working principles are discussed and, where relevant, connected to the pathophysiological background of equine ventilation. The objective of this review is to demystify ventilation modes and ventilators used in equine anaesthesia over the last two decades. In addition, this review aims to provide a practical guide to what the anaesthetist needs to consider before using CMV, how CMV can be delivered and monitored, and which principles need to be applied are included. Comparison of the clinical effects between spontaneous breathing and CMV is included.

Controlled mechanical ventilation (CMV) is routinely used in equine anaesthesia, with many different options available to mechanically deliver breaths. The complexity of respiratory pathophysiology in anaesthetised horses and the wide range of devices available is described in this scoping review. The first part of the review outlines basic equine respiratory physiology and pathophysiology during anaesthesia to illustrate what makes horses prone to inefficient gas exchange and ventilation when they are recumbent. The difference between spontaneous ventilation and CMV is reviewed and basic considerations of CMV are explored in more detail.

Alpha2 receptor agonists (alpha2-agonists) are useful sedative and analgesic agents in sheep, but have adverse pulmonary effects, which are reportedly similar between different alpha2-agonists. This randomized crossover study compared pulmonary function after intravenous administration of an alpha2-agonist, either xylazine or an equipotent dose of medetomidine in 34 female sheep anaesthetized twice. Pulmonary function was assessed using spirometry, volumetric capnography, arterial blood gas analysis 1 min prior to, and 5 and 10 min after administration of the allocated alpha 2 agonist drug. Pulmonary structural changes were subsequently assessed using computed tomography (CT). Tachypnoea or hypoxaemia prompted reversal with atipamezole and exclusion of data. Data were analysed for a fixed effect of drug using a mixed effect linear model with significance set at p 2), and lower dynamic compliance, tidal volume, CO2 elimination and end tidal CO2 tension and arterial oxygen tension than medetomidine. This was associated with a significantly lower % of aerated tissue and higher % poorly and non-aerated tissue in CT images of sheep receiving xylazine versus medetomidine. In conclusion, xylazine administration produced marked decreases in pulmonary function, in ventilated isoflurane anaesthetized sheep, when compared to an equipotent dose of medetomidine when administered as an intravenous bolus supporting the use of medetomidine when alpha2-agonists are required.

Electrical impedance tomography (EIT) is used in lung physiology monitoring. There is evidence that EIT is linearly associated with global tidal volume (VT) in clinically healthy patients where no positive end-expiratory pressure (PEEP) is applied. This linearity has not been challenged by altering lung conditions. The aim of this study was to determine the effect of PEEP on VT estimation, using EIT technology and spirometry, and observe the stability of the relationship under changing lung conditions. Twelve male castrated cattle (Steer), mean age 7.8 months (SD ± 1.7) were premedicated with xylazine followed by anaesthesia induction with ketamine and maintenance with halothane in oxygen via an endotracheal tube. An EIT belt was applied around the thorax at the level of the fifth intercostal space. Volume controlled ventilation was used. PEEP was increased in a stepwise manner from 0 to 5, 10 and 15 cmH2O. At each PEEP, the VT was increased stepwise from 5 to 10 and 15 mL kg−1. After a minute of stabilisation, total impedance change (VTEIT), using EIT and VT measured by a spirometer connected to a flow-partitioning device (VTSpiro) was recorded for the following minute before changing ventilator settings. Data was analysed using linear regression and multi variable analysis. There was a linear relationship between VTEIT and VTSpiro at all levels of PEEP with an R2 of 0.71, 0.68, 0.63 and 0.63 at 0, 5, 10 and 15 cmH2O, respectively. The variance in VTEIT was best described by peak inspiratory pressure (PIP) and PEEP (adjusted R2 0.82) while variance in VTSpiro was best described by PIP and airway deadspace (adjusted R2 0.76). The relationship between VTEIT and VTSpiro remains linear with changes in tidal volume, and stable across altered lung conditions. This may have application for monitoring and assessment in vivo.

Electrical impedance tomography measurements of regional ventilation and perfusion applied to etorphine-immobilized white rhinoceroses in lateral recumbency revealed a pronounced disproportional shift of the measured ventilation and perfusion toward the nondependent lung. The dependent lung was minimally ventilated and perfused, but still aerated. Perfusion was found primarily around the hilum of the nondependent lung. These shifts can explain the gas exchange impairments found in this study. Breath holding can redistribute ventilation.

BACKGROUND Electrical impedance tomography (EIT) generates thoracic impedance images of the lungs and has been used to assess ventilation in horses. This technique may have application in the detection of changes in airflow associated with equine asthma. OBJECTIVES The objective was to determine if histamine-induced airflow changes observed with flowmetric plethysmography (Δflow) could also be explained using global and regional respiratory gas flow signals calculated from EIT signals. STUDY DESIGN Experimental in vivo study. METHODS Six horses, sedated using detomidine were fitted with a thoracic EIT belt and flowmetric plethysmography hardware. Saline (baseline = BL) and increasing concentrations of histamine (C1-4) were nebulised into the face mask until a change in breathing pattern was clinically confirmed and Δflow increased greater or equal to 50%. After nebulisation Δflow and EIT images were recorded over 3 minutes and peak global inspiratory (InFglobal ) and expiratory (ExFglobal ) flow as well as peak regional expiratory and inspiratory flow for the dorsal and the ventral area of the right and left lungs were evaluated. Delta flow, InFglobal and ExFglobal at subsequent concentrations were indexed to baseline (yi = Ci /BL-1). Indexed and nonindexed variables were evaluated for a difference from baseline at sequential histamine doses (time). Multiple linear regression assessment of variance in delta flow was also investigated. RESULTS Consistent with histamine-provoked increases in Δflow, the global flow indices increased significantly. A significant increase in regional inspiratory flow was seen in the right and left ventral lung and dorsal right lung. Multiple regression revealed that the variance in ExFglobal , and right and left ventral expiratory flow best explained the variance in Δflow (r2 = .82). MAIN LIMITATIONS Low number of horses and horses were healthy. CONCLUSIONS Standardised changes in airflow during histamine challenge could be detected using EIT gas flow variables.

Objective: To describe some cardiorespiratory effects of an inspiratory-to-expiratory (IE) ratio of 1:1 compared with 1:3 in ventilated horses in dorsal recumbency. Study design: Randomized crossover experimental study. Animals: A total of eight anesthetized horses, with 444 (330–485) kg body weight [median (range)]. Methods: Horses were ventilated in dorsal recumbency with a tidal volume of 15 mL kg–1 and a respiratory rate of 8 breaths minute–1, and IE ratios of 1:1 (IE1:1) and 1:3 (IE1:3) in random order, each for 25 minutes after applying a recruitment maneuver. Spirometry, arterial blood gases and dobutamine requirements were recorded in all horses during each treatment. Electrical impedance tomography (EIT) data were recorded in four horses and used to generate functional EIT variables including regional ventilation delay index (RVD), a measure of speed of lung inflation, and end-expiratory lung impedance (EELI), an indicator of functional residual capacity (FRC). Results were assessed with linear and generalized linear mixed models. Results: Compared with treatment IE1:3, horses ventilated with treatment IE1:1 had higher mean airway pressures and respiratory system compliance (p < 0.014), while peak, end-inspiratory and driving airway pressures were lower (p < 0.001). No differences in arterial oxygenation or dobutamine requirements were observed. PaCO2 was lower in treatment IE1:1 (p = 0.039). Treatment IE1:1 resulted in lower RVD (p < 0.002) and higher EELI (p = 0.023) than treatment IE1:3. Conclusions and clinical relevance: These results suggest that IE1:1 improved respiratory system mechanics and alveolar ventilation compared with IE1:3, whereas oxygenation and dobutamine requirements were unchanged, although differences were small. In the four horses where EIT was evaluated, IE1:1 led to a faster inflation rate of the lung, possibly the result of increased FRC. The clinical relevance of these findings needs to be further investigated., Fil: Pittman, Ella. Cornell University. College of Veterinary Medicine. Department of Clinical Sciences; Estados Unidos, Fil: Martin-Flores, Manuel. Cornell University. College of Veterinary Medicine. Department of Clinical Sciences; Estados Unidos, Fil: Mosing, Martina. Murdoch University. School of Veterinary Medicine; Australia, Fil: Lorenzutti, Matias. Universidad Católica de Córdoba. Facultad de Ciencias Veterinarias. Pharmacology and Toxicology; Argentina, Fil: Retamal, Jaime. Pontificia Universidad Católica de Chile. Facultad de Medicina. Departamento de Medicina Intensiva; Chile, Fil: Staffieri, Francesco. “Aldo Moro” University of Bari. Department of Emergency and Organ Transplantation D.E.O.T. Section of Veterinary Clinics and Animal Production; Italia, Fil: Adler, Andy. Carleton University. Systems and Computer Engineering; Canada, Fil: Campbell, Mark. Systems and Computer Engineering; Canada, Fil: Araos, Joaquin. Cornell University. College of Veterinary Medicine. Department of Clinical Sciences; Estados Unidos

This study explores the application of electric impedance tomography (EIT) to estimate tidal volume (VT) by measuring impedance change per breath (∆Zbreath). Seventeen healthy horses were anaesthetised and mechanically ventilated for elective procedures requiring dorsal recumbency. Spirometric VT (VTSPIRO) and ∆Zbreath were recorded periodically, up to six times throughout anaesthesia. Part 1 assessed these variables at incremental delivered VT of 10, 12 and 15 mL/kg. Part 2 estimated VT (VTEIT) in litres from ∆Zbreath at three additional measurement points using a line of best fit obtained from Part 1. During part 2, VT was adjusted to maintain end-tidal carbon dioxide between 45–55 mmHg. Linear regression determined the correlation between VTSPIRO and ∆Zbreath (part 1). Estimated VTEIT was assessed for agreement with measured VTSPIRO using Bland Altman analysis (part 2). Marked variability in slope and intercepts was observed across horses. Strong positive correlation between ∆Zbreath and VTSPIRO was found in each horse (R2 0.9–0.99). The agreement between VTEIT and VTSPIRO was good with bias (LOA) of 0.26 (−0.36–0.88) L. These results suggest that, in anaesthetised horses, EIT can be used to monitor and estimate VT after establishing the individual relationship between these variables.

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This study used electrical impedance tomography (EIT) measurements of regional ventilation and perfusion to elucidate the reasons for severe gas exchange impairment reported in rhinoceroses during opioid-induced immobilization. EIT values were compared with standard monitoring parameters to establish a new monitoring tool for conservational immobilization and future treatment options. Six male white rhinoceroses were immobilized using etorphine, and EIT ventilation variables, venous admixture, and dead space were measured 30, 40, and 50 min after becoming recumbent in lateral position. Pulmonary perfusion mapping using impedance-enhanced EIT was performed at the end of the study period. The measured impedance (∆Z) by EIT was compared between pulmonary regions using mixed linear models. Measurements of regional ventilation and perfusion revealed a pronounced disproportional shift of ventilation and perfusion toward the nondependent lung. Overall, the dependent lung was minimally ventilated and perfused, but remained aerated with minimal detectable lung collapse. Perfusion was found primarily around the hilum of the nondependent lung and was minimal in the periphery of the nondependent and the entire dependent lung. These shifts can explain the high amount of venous admixture and physiological dead space found in this study. Breath holding redistributed ventilation toward dependent and ventral lung areas. The findings of this study reveal important pathophysiological insights into the changes in lung ventilation and perfusion during immobilization of white rhinoceroses. These novel insights might induce a search for better therapeutic options and is establishing EIT as a promising monitoring tool for large animals in the field.

Electrical impedance tomography (EIT) provides clinically useful lung images; however, it would be an advantage to extract additional cardiovascular information from the data. The aim of this study was to evaluate if cardiac-related changes measured by EIT can be used to measure pulse rate (PR) under physiological as well as high and low blood pressure states in anaesthetised horses. Electrical impedance tomography data and PR from seven horses anaesthetised in dorsal recumbency were recorded over 1 min during mechanical ventilation and 1 min of apnoea. Data were collected at four measurement time points; before and during intravenous administration of nitroprusside and phenylephrine, respectively. Nine pixels, estimated to represent the heart, were chosen from the EIT image. A novel algorithm detected peaks of impedance change for these pixels over 10 s intervals. Concurrent PR measured using an invasive blood pressure trace, was recorded every 10 s. EIT- and pulse-rate data were compared using Bland-Altman assessment for multiple measurements on each horse. Overall, 288 paired datasets from six of seven horses were available for analysis. There was excellent agreement for baseline measurements, as well as during hypertension and hypotension, with a bias of −0.26 and lower and upper limit of agreement at −2.22 (95% confidence intervals [CI], −2.89 to −1.86) and 1.69 (95% CI, 1.34–2.36) beats per min, respectively. EIT can be used to evaluate PR using cardiac-related impedance changes. More work is required to determine bias that might occur in anaesthetised horses in other recumbencies or clinical situations.

Objective. A linear relationship between impedance change (ΔZ) measured by thoracic electrical impedance tomography (EIT) and tidal volume (VT) has been demonstrated. This study evaluated the agreement between the displayed VT calculated by the EIT software (VTEIT) and spirometry (VTSPIRO) after an indirect two-point calibration. Approach. The EIT software was programmed to execute a bedside two-point calibration from the subject-specific, linear equation defining the relationship between ΔZ and VTSPIRO and displaying VTEIT breath-by-breath in 20 neutered male, juvenile pigs. After EIT calibration VTs of 8, 12, 16 and 20 ml kg−1 were applied to the lungs. VTEIT and VTSPIRO were recorded and analysed using Bland–Altman plot for multiple subject measurements. Volumetric capnography (VCap) and spirometry data were explored as components of variance using multiple regression. Main results. A mean relative difference (bias) of 0.7% with 95% confidence interval (CI) of −10.4% to 10.7% were found between VTEIT and VTSPIRO for the analysed data set. The variance in VTEIT could not be explained by any of the measured VCap or spirometry variables. Significance. The narrow CI estimated in this study allows the conclusion that EIT and its software can be used to measure and accurately convert ΔZ into mililitre VT at the bedside after applying an indirect two-point calibration.

Objective To describe the cardiorespiratory effects of a change in table position in anaesthetized horses. Study design Prospective, crossover, randomized, experimental study. Animals Six adult horses (mean body weight 621 ± 59 kg, aged 13 ± 4 years). Methods The horses were anaesthetized twice in dorsal recumbency. They were either placed in the Trendelenburg position (head down; HD) followed by reverse Trendelenburg position (head up; HU) or in reverse order. Every position was maintained for 90 minutes. The order of positions was randomly assigned at initial anaesthesia. Extensive cardiorespiratory monitoring was performed. Statistical analysis consisted of a mixed model with horses as random effect and time, position, section of anaesthesia and interaction between those as fixed effects (p Results When HU was applied during the first section of anaesthesia, PaO2, (p = 0.012), oxygen saturation (SaO2, p Q ˙ s/ Q ˙ t, p Q ˙ s/ Q ˙ t lower compared to the inverse order. Independent of the order, in the HD position Q ˙ s/ Q ˙ t (p = 0.019) increased while PaO2 (p v ¯ O2; p = 0.019), venous saturation (p = 0.004) and venous oxygen content (p = 0.010) decreased over time. No significant differences were found for cardiac output, oxygen delivery, oxygen consumption and dobutamine requirement between the two positions. Conclusions and clinical relevance Gas exchange is better preserved in HU compared to HD, especially if applied from the start of the anaesthesia.

Background: Electrical impedance tomography (EIT) is a method to measure regional impedance changes within the thorax. The total tidal impedance variation has been used to measure changes in tidal volumes in pigs, dogs and men. Objectives: To assess the ability of EIT to quantify changes in tidal volume in anaesthetised mechanically ventilated horses. Study design: In vivo experimental study. Methods: Six horses (mean ± s.d.: age 11.5 ± 7.5 years and body weight 491 ± 40 kg) were anaesthetised using isoflurane in oxygen. The lungs were mechanically ventilated using a volume-controlled mode. With an end-tidal carbon dioxide tension in the physiological range, and a set tidal volume (VTvent) of 11–16 mL/kg (baseline volume), EIT data and VT measured by conventional spirometry were collected over 1 min. Thereafter, VTvent was changed in 1 L steps until reaching 10 L. After, VTvent was reduced to 1 L below the baseline volume and then further reduced in 1 L steps until 4 L. On each VT step data were recorded for 1 min after allowing 1 min of stabilisation. Impedance changes within the predefined two lung regions of interest (EITROI) and the whole image (EITthorax) were calculated. Linear regression analysis was used to assess the relationship between spirometry data and EITROI and EITthorax for individual horses and pooled data. Results: Both EITROI and EITthorax significantly predicted spirometry data for individual horses with R2 ranging from 0.937 to 0.999 and from 0.954 to 0.997 respectively. This was similar for pooled data from all six horses with EITROI (R2 = 0.799; P

To determine the agreement of invasive blood pressure measured in the facial, metatarsal and carotid arteries, and evaluate the effects of two haemodynamic conditions on agreement.Prospective randomized study.A group of eight horses aged 7 (4-23) years with a body weight of 493 ± 33 kg.Horses were anaesthetized and positioned in dorsal recumbency. Invasive blood pressure was measured simultaneously via catheters placed in the facial, metatarsal and carotid arteries. Cardiovascular function and agreement between arteries was assessed before and during administration of phenylephrine and sodium nitroprusside. These were administered until carotid mean pressure (MAPc) increased or decreased from baseline (65 ± 5) to90 or50 mmHg, respectively. Data recorded at each sample time included systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressures for carotid (c), facial (f) and metatarsal (m) arteries as well as cardiac output (Q˙t) and systemic vascular resistance (SVR). Bland-Altman analysis was used to assess agreement between peripheral and central sites, and regression analysis to determine influence of Q˙t and SVR.The largest difference was observed in SAPc and SAPm with a bias and limits of agreement (LOA) of 2 (-15 to 19) mmHg. The bias (LOA) for MAPc and MAPf was 2 (-4 to 9) mmHg and for MAPc and MAPm was 5 (-4 to 14) mmHg. The best agreement for DAP was seen between DAPc and DAPf with bias (LOA) of 1 (-3 to 5) mmHg. Regression analysis indicated marginal influence on agreement by Q˙t on MAPc and MAPf.MAP and DAP of the carotid artery were higher than those of the peripheral arteries, which may lead to overzealous treatment of hypotension, albeit maintaining central pressures. Q˙t and SVR did not largely influence the difference between sites.

Objective To evaluate three routinely used tidal volumes (VT; 10, 12 and 15 mL kg−1) for controlled mechanical ventilation (CMV) in lung-healthy anaesthetized dogs by assessing alveolar ventilation (VTalv) and dead space (DS). Study design Prospective, randomized clinical trial. Animals A total of 36 client-owned dogs. Methods Dogs were randomly allocated to a VT of 10 (G10), 12 (G12) or 15 (G15) mL kg−1. After induction CMV was started. End-tidal carbon dioxide tension was maintained at 4.7–5.3 kPa by changing the respiratory frequency (fR; 6 anova and Student–Newman–Keuls tests with a statistical significance set at p Results No differences were observed for demographic data and cardiovascular variables between groups. A total of three dogs were excluded because of technical difficulties and one because of fR > 30. VTalv kg−1 (p = 0.001) increased and VDBohr (p = 0.002) decreased with greater VT. VTCO2,br (p = 0.017) increased and VDaw/VT (p = 0.006), VDBE (p = 0.008) and fR (p = 0.002) decreased between G10 and G15. PIP (p = 0.013) was significantly higher in G15 compared with that in G10 and G12. No changes were observed in MawP. Conclusions and clinical relevance A VT of 15 mL kg−1 is most appropriate for CMV in lung-healthy dogs (as evaluated by respiratory mechanics and VCap) and does not impair cardiovascular variables.

Objective To compare airway management during induction of anaesthesia, spontaneous ventilation (SV) and controlled mechanical ventilation (CMV), using an endotracheal tube (ETT), laryngeal mask (LM), rabbit-specific supraglottic airway device (v-gel) or facemask (FM). Study design Prospective randomized crossover experiment. Animals Ten New Zealand White rabbits. Methods After premedication, rabbits were randomly allocated to four groups: 1) ETT; 2) LM; 3) v-gel or 4) FM. The required dose of propofol, duration and number of attempts to place an airway device and leakage during SV and CMV at different peak inspiratory pressures (6, 10, 12, 14 and 16 cmH2O) were recorded. Computed tomography (CT) of the head, neck and abdomen were performed before and after CMV. Results Significantly less propofol and time [2.0 ± 0.5 mg kg−1, 82 ± 34 seconds, p 25% of the tidal volume occurred at the lowest pressure in FM [median (range), 6 (6–8) cmH2O], which was significantly lower than with v-gel [16 (6–no leak at 16) cmH2O], LM [>16 (6–no leak at 16)] or ETT [>16 (no leak at 16) cmH2O] (p Conclusions and clinical relevance The v-gel is a practical alternative to LM and ETT for airway management and CMV, but can compress the larynx. The FM is easily placed, but significant leakage occurs during CMV.

BACKGROUND: Arterial hypoxaemia is common in anaesthetised horses, but little information exists regarding restoration of arterial oxygen tension (PaO₂) during recovery from anaesthesia, or if intra‐operative management factors exert any longer‐term effect. OBJECTIVES: To evaluate PaO₂ in horses recovering from general anaesthesia up to 1 h after resuming standing. STUDY DESIGN: Prospective observational clinical cohort study. METHODS: Systemically healthy adult horses undergoing inhalational general anaesthesia for elective surgical procedures were studied. Arterial blood samples were obtained anaerobically prior to pre‐anaesthetic medication, at end of anaesthesia, immediately following positioning in the recovery box, then at 10‐min intervals until standing. Additionally, samples were taken when horses achieved sternal recumbency, at standing (STAND) and 1 h after standing (STAND+1). Data were analysed using ANOVA and mixed‐effects linear regression, with significance set at P

Objective Adenosine induces vasodilatation. The aim of this study was to investigate cardiovascular effects of two adenosine constant rate infusion (CRI) doses in dogs. Study design Experimental, longitudinal repeated measure design. Animals Ten healthy purpose-bred Beagle dogs. Methods Each dog was sedated with butorphanol. Anaesthesia was induced with propofol intravenously and maintained with sevoflurane (inspired oxygen fraction = 47–55%). Controlled mechanical ventilation was used to maintain normocapnia. Two doses of adenosine were administered as CRIs to each dog: 140 μg kg–1 minute–1 (A140) followed by 280 μg kg–1 minute–1 (A280). Pulse rate, invasive arterial pressure and stroke volume (by magnetic resonance phase contrast angiography) were measured at baseline, 3 minutes after starting adenosine and 3 and 10 minutes after discontinuing adenosine. Cardiac output, cardiac index and approximated systemic vascular resistances (approximate SVR) were calculated. Additionally, arterial blood gases, co-oximetry, electrolytes, glucose and lactate were measured and oxygen content and delivery calculated. One-way repeated measures analysis of variance (p Results A140 and A280 resulted in a significant decrease in arterial blood pressure [systolic (p = 0.008), mean (p = 0.003), and diastolic arterial pressure (p = 0.004)] and approximate SVR (p = 0.008) compared with baseline. No significant changes were detected for the other variables. All values returned to baseline within 3 minutes after adenosine discontinuation. Conclusions and clinical relevance Adenosine CRI decreases arterial pressure by vasodilatation in healthy dogs. No additional effects were observed with the higher dose. The effects in compromised dogs remain to be investigated.

OBJECTIVE In EIT applications to the thorax, a single electrode plane has typically been used to reconstruct a transverse 2D 'slice'. However, such images can be misleading as EIT is sensitive to contrasts above and below the electrode plane, and ventilation and aeration inhomogeneities can be distributed in complex ways. Using two (or more) electrode planes, 3D EIT images may be reconstructed, but 3D reconstructions are currently little used in thoracic EIT. In this paper, we investigate an incremental pathway towards 3D EIT reconstructions, using two electrode planes to calculate improved transverse slices as an intermediate step. We recommend a specific placement of electrode planes, and further demonstrate the feasibility of multi-slice reconstruction in two species. APPROACH Simulations of the forward and reconstructed sensitivities were analysed for two electrode planes using a 'square' pattern of electrode placement as a function of two variables: the stimulation and measurement 'skip', and the electrode plane separation. Next, single- versus two-plane measurements were compared in a horse and in human volunteers. We further show the feasibility of 3D reconstructions by reconstructing multiple transverse and, unusually, frontal slices during ventilation. MAIN RESULTS Using two electrode planes leads to a reduced position error and improvement in off-plane contrast rejection. 2D reconstructions from two-plane measurements showed better separation of lungs, as compared to the single plane measurements which tend to push contrasts in the center of the image. 3D reconstructions of the same data show anatomically plausible images, inside as well as outside the volume between the two electrode planes. SIGNIFICANCE Based on the results, we recommend EIT electrode planes separated by less than half of the minimum thoracic dimension with a 'skip 4' pattern and 'square' placement to produce images with good slice selectivity.

Objective To assess changes in the distribution in pulmonary ventilation in anaesthetized ponies using Electrical Impedance Tomography (EIT). Study design Prospective experimental study Animals Eight adult ponies geldings Methods General anaesthesia was induced and maintained using isoflurane in oxygen with volume-controlled ventilation [tidal volume (10 mL kg-1), respiratory rate (8 – 12 breaths minute-1)] to maintain end-tidal carbon dioxide between 35 and 40 mmHg (4.66–5.32 kPa). Regional distribution of ventilation was assessed with EIT (plane of 5th to 6th intercostal space) at 30, 60 and 90 minutes after intubation. The resulting functional images were divided into four regions of interest (ROI, A - D) to determine 1) the ratio of tidal volume distribution between dependent to non-dependent lung (D/ND), 2) changes in distribution within the lungs in latero-lateral direction. The centre of ventilation (COV) was calculated. The dimension of the chest in latero-lateral (W) and dorso-ventral (H) direction was measured at the height of the withers and the W/H ratio was calculated. The influence of time on D/ND ratio, COV and ROI A – D were analysed with ANOVA followed by post-hoc Bonferroni tests. Pearson correlation coefficient and the coefficient of determination (r2) were calculated to evaluate the relationship between W/H ratio and D/ND ratio, and COV. Statistical significance was set at p < 0.05. Results The median D/ND ratio (T30 to T90) was 0.67 (0.40 -1.01) and for COV 31.15% (11.20-45.20), confirming the expected uneven distribution of ventilation. The D/ND ratio had a moderate negative correlation with the W/H ratio (r = -0.68, r2 = 0.46, p = 0.000), while the COV did not correlate with the W/H ratio (r = -0.04). Conclusion and clinical relevance: Uneven ventilation in mechanically ventilated right laterally recumbent anaesthetised ponies occurs within thirty minutes and changed little over the following 60 minutes.

In the first edition of this journal, Barbara Weaver wrote a review titled 'Equine Anaesthesia', stating that, at that time, it was quickly becoming accepted practice that many horses were being anaesthetised 'by essentially similar procedures, i.e. premedication, induction and then maintenance by controlled inhalation'. To celebrate the 50th anniversary of the first edition of this journal, this review covers the development of understanding and practice of inhalational anaesthesia and controlled ventilation in horses over the last 50 years. We review how the perceived benefits of halothane led to its widespread use, but subsequently better understanding of halothane's effects led to changes in equine anaesthetic practice and the utilisation of different inhalation agents (e.g. isoflurane and sevoflurane). We discuss how more recently, better understanding of the effects of the 'newer' inhalation agents' effects has led to yet more changes in equine anaesthetic practice, and while, further new inhalation agents are unlikely to appear in the near future, further enhancements to anaesthetic practice may still lead to improved outcomes. We review advances in our understanding of the anatomy and pathophysiology of the equine lung as well of the effects of anaesthesia on lung function and how these predispose to some of the common problems of gas exchange and ventilation during anaesthesia. We identify the aims of optimal mechanical ventilation for anaesthetic management and whether the various methods of ventilatory support during equine anaesthesia achieve them. We also highlight that further developments in equipment and optimal ventilator modes are likely in the near future.

The arterial to end-tidal CO2 difference (P(a-ET)CO2) and alveolar dead space fraction (VDalvfrac = P(a-ET)CO2/PaCO2), are used to estimate Enghoff's "pulmonary dead space" (V/QEng), a factor which is also influenced by venous admixture and other pulmonary perfusion abnormalities and thus is not just a measure of dead space as the name suggests. The aim of this experimental study was to evaluate which factors influence these CO2 indices in anesthetized spontaneously breathing horses. Six healthy adult horses were anesthetized in dorsal recumbency breathing spontaneously for 3 h. Data to calculate the CO2 indices (response variables) and dead space variables were measured every 30 min. Bohr's physiological and alveolar dead space variables, cardiac output (CO), mean pulmonary pressure (MPP), venous admixture [Formula: see text], airway dead space, tidal volume, oxygen consumption, and slope III of the volumetric capnogram were evaluated (explanatory variables). Univariate Pearson correlation was first explored for both CO2 indices before V/QEng and the explanatory variables with rho were reported. Multiple linear regression analysis was performed on P(a-ET)CO2 and VDalvfrac assessing which explanatory variables best explained the variance in each response. The simplest, best-fit model was selected based on the maximum adjusted R2 and smallest Mallow's p (Cp). The R2 of the selected model, representing how much of the variance in the response could be explained by the selected variables, was reported. The highest correlation was found with the alveolar part of V/QEng to alveolar tidal volume ratio for both, P(a-ET)CO2 (r = 0.899) and VDalvfrac (r = 0.938). Venous admixture and CO best explained P(a-ET)CO2 (R2 = 0.752; Cp = 4.372) and VDalvfrac (R2 = 0.711; Cp = 9.915). Adding MPP (P(a-ET)CO2) and airway dead space (VDalvfrac) to the models improved them only marginally. No "real" dead space variables from Bohr's equation contributed to the explanation of the variance of the two CO2 indices. P(a-ET)CO2 and VDalvfrac were closely associated with the alveolar part of V/QEng and as such, were also influenced by variables representing a dysfunctional pulmonary perfusion. Neither P(a-ET)CO2 nor VDalvfrac should be considered pulmonary dead space, but used as global indices of V/Q mismatching under the described conditions.

OBJECTIVE To compare the efficacy of three continuous positive airway pressure (CPAP) interfaces in dogs on gas exchange, lung volumes, amount of leak during CPAP and rebreathing in case of equipment failure or disconnection. STUDY DESIGN Randomized, prospective, crossover, experimental trial. ANIMALS Ten purpose-bred Beagle dogs. METHODS Dogs were in dorsal recumbency during medetomidine-propofol constant rate infusions, breathing room air. Three interfaces were tested in each dog in a consecutive random order: custom-made mask (M), conical face mask (FM) and helmet (H). End-expiratory lung impedance (EELI) measured by electrical impedance tomography was assessed with no interface (baseline), with the interface only (No-CPAP for 3 minutes) and at 15 minutes of 7 cmHO CPAP (CPAP-delivery). PaO was assessed at No-CPAP and CPAP-delivery, partial pressure of inspired carbon dioxide (PICO; rebreathing assessment) at No-CPAP and the interface leak (ΔP) at CPAP-delivery. Mixed-effects linear regression models were used for statistical analysis (p

The arterial to end-tidal CO2 difference (P(a-ET)CO2) and alveolar dead space fraction (VDalvfrac = P(a-ET)CO2/PaCO2), are used to estimate Enghoff’s “pulmonary dead space” (V/QEng), a factor which is also influenced by venous admixture and other pulmonary perfusion abnormalities and thus is not just a measure of dead space as the name suggests. The aim of this experimental study was to evaluate which factors influence these CO2 indices in anesthetized spontaneously breathing horses. Six healthy adult horses were anesthetized in dorsal recumbency breathing spontaneously for 3 h. Data to calculate the CO2 indices (response variables) and dead space variables were measured every 30 min. Bohr’s physiological and alveolar dead space variables, cardiac output (CO), mean pulmonary pressure (MPP), venous admixture (Q˙s​/​Q˙t), airway dead space, tidal volume, oxygen consumption, and slope III of the volumetric capnogram were evaluated (explanatory variables). Univariate Pearson correlation was first explored for both CO2 indices before V/QEng and the explanatory variables with rho were reported. Multiple linear regression analysis was performed on P(a-ET)CO2 and VDalvfrac assessing which explanatory variables best explained the variance in each response. The simplest, best-fit model was selected based on the maximum adjusted R2 and smallest Mallow’s p (Cp). The R2 of the selected model, representing how much of the variance in the response could be explained by the selected variables, was reported. The highest correlation was found with the alveolar part of V/QEng to alveolar tidal volume ratio for both, P(a-ET)CO2 (r = 0.899) and VDalvfrac (r = 0.938). Venous admixture and CO best explained P(a-ET)CO2 (R2 = 0.752; Cp = 4.372) and VDalvfrac (R2 = 0.711; Cp = 9.915). Adding MPP (P(a-ET)CO2) and airway dead space (VDalvfrac) to the models improved them only marginally. No “real” dead space variables from Bohr’s equation contributed to the explanation of the variance of the two CO2 indices. P(a-ET)CO2 and VDalvfrac were closely associated with the alveolar part of V/QEng and as such, were also influenced by variables representing a dysfunctional pulmonary perfusion. Neither P(a-ET)CO2 nor VDalvfrac should be considered pulmonary dead space, but used as global indices of V/Q mismatching under the described conditions.

Objective The aim of this study was to evaluate the effect of continuous positive airway pressure (CPAP) on regional distribution of ventilation and dead space in anaesthetized horses. Study design Randomized, experimental, crossover study. Animals A total of eight healthy adult horses. Methods Horses were anaesthetized twice with isoflurane in 50% oxygen and medetomidine as continuous infusion in dorsal recumbency, and administered in random order either CPAP (8 cmH2O) or NO CPAP for 3 hours. Electrical impedance tomography (and volumetric capnography (VCap) measurements were performed every 30 minutes. Lung regions with little ventilation [dependent silent spaces (DSSs) and nondependent silent spaces (NSSs)], centre of ventilation (CoV) and dead space variables, as well as venous admixture were calculated. Statistical analysis was performed using multivariate analysis of variance and Pearson correlation. Results Data from six horses were statistically analysed. In CPAP, the CoV shifted to dependent parts of the lungs (p Conclusions and clinical relevance In dorsally recumbent anaesthetized horses, CPAP of 8 cmH2O results in redistribution of ventilation towards the dependent lung regions, thereby improving ventilation-perfusion matching. This improvement was not associated with an increase in dead space indicative for a lack in distension of the airways or impairment of alveolar perfusion.