A 43-yr-old woman experienced acute respiratory failure with right ventricular dysfunction following a complex left pneumonectomy (fig. 1A) with cardiopulmonary bypass. She was intubated and mechanically ventilated.

Electrical impedance tomography was employed to assess ventilation distribution and pulmonary perfusion. The ventilation distribution was determined by detecting tidal changes in impedance throughout the respiratory cycle, whereas the pulmonary perfusion assessment was performed through a breath-hold maneuver with a 10-ml injection of 7.5% saline solution, inducing impedance alterations.1,2  The amplitude and slope of curves after saline injection were calculated and used as surrogates of pulmonary blood volume and flow, respectively. Last, ventilation and perfusion impedance signals were integrated into an electrical impedance tomography ventilation/perfusion match map. The ventilation/perfusion match map defines regions of even match between the mostly ventilated and mostly perfused regions.

Subsequently, inhaled nitric oxide at 20 ppm was administered. The pulmonary perfusion curves...

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