Ventilation inhomogeneity in Duchenne muscular dystrophy before the initiation of ventilatory support: Insights from electrical impedance tomography

Background Prior to the onset of overt ventilatory failure, patients with Duchenne Muscular Dystrophy (DMD) can display non-uniform respiratory mechanics, resulting from atelectasis in small lung regions secondary to rapid, shallow breathing and/or peripheral airway obstruction, thereby predisposing to the development of ventilation inhomogeneity.Objectives To investigate ventilation distribution in DMD patients before the initiation of long-term assisted ventilation by using electrical impedance tomography (EIT).Methods Patients and interventions: Eighteen DMD patients underwent EIT between 1 January and 31 December 2025. Primary study endpoint: Global Inhomogeneity Index (GI). EIT data were compared with those obtained from a group of 11 healthy, similarly aged male medical residents.Results GI was significantly higher in the DMD patients with respect to healthy males [0.44 ± 0.13 (0.36–0.77) vs 0.37 ± 0.03 (0.32–0.43); p < 0.001]. A GI of 0.5 maximised the distinction between DMD patients with a ventilation distribution pattern similar to or different from the healthy subjects.Conclusions Before initiation of assisted ventilation, a subset of DMD patients may develop lung ventilation inhomogeneity, which can be readily assessed by means of EIT. Whether such inhomogeneity is predictive of major clinical events therefore constitutes a critical question to be addressed.