Can regional lung mechanics evaluation represent the next step towards precision medicine in respiratory care?

Over the last few decades, many randomized clinical trials (RCTs) focused on critically ill patients undergoing mechanical ventilation have showed negative results.This is true for both RCTs testing different mechanical ventilation strategies or pharmacological interventions. Some authors advocate the heterogeneity in patients’ responses to intervention as one of the main confounding factors leading to negative RCT. An accurate prediction of individual patient therapeutic responses is necessary to overcome the challenge of patient heterogeneity. In this issue of Minerva Anestesiologica, Zhao et al. investigated the response to a combination of inhaled corticosteroid and β2 agonist on patients undergoing mechanical ventilation due to acute exacerbation of obstructive lung disease or severe asthma. The rationale behind the study was that conventional global lung function could not correctly address the response to therapy due to spatial inhomogeneity. Patients were monitored with the electrical impedance tomography (EIT), a non-invasive monitoring tool which allows a breath-to-breath bedside evaluation of pulmonary ventilation. One of the main advantages given by EIT is the ability to evaluate continuously the mechanical properties of different lung regions, otherwise unrecognizable by global respiratory mechanics.