Thoracic electrical impedance tomography in China: a nationwide survey of clinical implementation, practice variation, and barriers

Thoracic electrical impedance tomography (EIT) has increasingly entered bedside respiratory care, but its real-world implementation remains incompletely characterized in mainland China. We conducted a nationwide survey to investigate current patterns of clinical use, operational practice, technical barriers, and implementation needs for thoracic EIT. A cross-sectional electronic survey was conducted among ICU professionals in mainland China, predominantly in tertiary hospitals. The questionnaire covered demographics, protocols, and barriers. Subgroup analysis was performed to compare practice patterns between physicians and respiratory therapists (RTs). A total of 210 valid responses from 126 hospitals across 24 provinces were analyzed. Respiratory therapists accounted for 71.9% of respondents. In a multiple-response item on clinical uses, 93.8% of respondents reported individualized ventilation guidance and 89.5% reported detection of ventilation/perfusion abnormalities; post hoc tabulation showed 10.0% reporting ventilation guidance only, 5.7% ventilation/perfusion abnormality detection only, and 83.8% both. 50.5% of respondents had also participated in EIT-related research. Among respondents, 61.9% reported that their department had one EIT device, 57.1% reported 1–2 years of EIT experience, and 73.3% reported manufacturer-led training. A 2 cmH₂O PEEP titration step was most commonly used, but titration duration varied substantially. Among those performing perfusion monitoring, 10% hypertonic saline, a 10 mL bolus, and end-expiratory injection were the dominant practices. Bedside decision-making relied mainly on regional ventilation distribution, EELV changes, and V/Q maps. Although quality-control measures were widely adopted, technical issues were reported at varying frequencies and documentation practices remained heterogeneous. The main barriers to broader implementation were lack of assisting staff and the time-consuming nature of the procedure, while interpretation guidance, standardized operating procedures, and reimbursement/reporting support were identified as the highest priorities for future development. Respondents from hospitals across mainland China reported broad but heterogeneous bedside use of thoracic EIT. Standardized training, interpretation, reporting, and reimbursement pathways may facilitate more consistent clinical adoption. Trial registration with ClinicalTrials.gov (NCT06954415) on May 1, 2025.