Skip to main content

Severe pressure ulcer caused by an electrode belt for monitoring electrical impedance tomography in two patients in the prone position

To the Editor,

Electrical impedance tomography (EIT) has emerged as a real-time dynamic monitoring technique for assessing pulmonary ventilation, which can be used to optimize mechanical ventilation for acute respiratory distress syndrome (ARDS) [1]. Also, prone ventilation is often performed for severe ARDS [2, 3]. Several studies have monitored the respiratory system using EIT during prone positioning [4, 5], and we believe that the combination of EIT monitoring and prone therapy will become more common in clinical practice for ARDS patients. Herein, we report two cases of pressure ulcers caused by the electrode belt of an EIT device (Enlight™ 2100, Medtronic, Minneapolis, MN, USA) placed on the chest during prone ventilation for ARDS in our intensive care unit. To the best of our knowledge, this is the first report of severe ulcers caused by an EIT device.

Case 1: An 81-year-old man (height 162 cm, body weight 62 kg, body mass index 23.6 kg/m2) who underwent subtotal esophagectomy for esophageal cancer developed pneumonia and severe ARDS on the third postoperative day. Lung-protective ventilation with neuromuscular blocking agents and EIT monitoring were performed with the patient in the prone position for 20 h. After prone ventilation, pressure ulcers were found in the left anterior axilla where the EIT electrode belt had been placed (Fig. 1a). After 3 months, the ulcers had not healed; rather, they had increased in size (Fig. 1b).

Fig. 1
figure 1

Skin lesions by an electrode belt for monitoring electrical impedance tomography in case 1. a Erythema and purpura in the left axilla and the upper arm immediately after prone to supine positioning. b Severe ulcer with extensive skin defects in the chest wall and the axilla 3 months later

Case 2: A 66-year-old man (height 170 cm, body weight 42 kg, body mass index 14.6 kg/m2) receiving chemotherapy for esophageal cancer developed bacterial pneumonia and severe ARDS. We used lung-protective ventilation with tracheal intubation and neuromuscular bloking agents, along with EIT monitoring, in the prone position for 19 h. After the prone ventilation, pressure ulcers were found on the anterior chest (Fig. 2).

Fig. 2
figure 2

Skin lesions without defects in the anterior chest wall by an electrode belt for electrical impedance tomography immediately after prone to supine positioning in case 2

We propose that EIT may be a risk factor for pressure ulcers. These two patients developed their pressure ulcers on the sites where the EIT electrode belt was in contact with their skin. During prone ventilation, we used cushions and pillows to relieve pressure and performed decompression every 2 h to prevent pressure-induced skin damage. However, it is not easy to achieve fully effective decompression with the patient in the prone position. In addition, both patients had risk factors for pressure ulcers, such as male gender, age ≥ 60 years, and low body mass index [6]. The findings of these cases suggest that the use of EIT devices as well as the said risk factors may induce pressure ulcers, potentially leading to prolonged hospital stay; therefore, careful attention should be paid to pressure ulcers, especially when EIT is used in the prone ventilation.

Availability of data and materials

Not applicable.



Electrical impedance tomography


Acute respiratory distress syndrome


  1. Bachmann MC, Morais C, Bugedo G, Bruhn A, Morales A, Borges JB, et al. Electrical impedance tomography in acute respiratory distress syndrome. Crit Care. 2018;22(1):263.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020;46(5):854–87.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, et al. An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195(9):1253–63.

    Article  PubMed  Google Scholar 

  4. Franchineau G, Bréchot N, Hekimian G, Lebreton G, Bourcier S, Demondion P, et al. Prone positioning monitored by electrical impedance tomography in patients with severe acute respiratory distress syndrome on veno-venous ECMO. Ann Intensive Care. 2020;10(1):12.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wang YX, Zhong M, Dong MH, Song JQ, Zheng YJ, Wu W, et al. Prone positioning improves ventilation-perfusion matching assessed by electrical impedance tomography in patients with ARDS: a prospective physiological study. Crit Care. 2022;26(1):154.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Girard R, Baboi L, Ayzac L, Richard JC, Guérin C, Proseva Trial Group. The impact of patient positioning on pressure ulcers in patients with severe ARDS: results from a multicentre randomised controlled trial on prone positioning. Intensive Care Med. 2014;40(3):397–403.

    Article  PubMed  Google Scholar 

Download references


The authors would like to thank the Scientific English Editing Section of Fukushima Medical University for their work on this manuscript.


No funding for this report.

Author information

Authors and Affiliations



THase managed the patient as an intensivist and prepared the manuscript. KY helped to draft the manuscript. THako managed the patient with Hasegawa. SI managed the patient and helped to draft the manuscript.

Corresponding author

Correspondence to Takayuki Hasegawa.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from the patients for publication of this case report.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hasegawa, T., Yoshida, K., Hakozaki, T. et al. Severe pressure ulcer caused by an electrode belt for monitoring electrical impedance tomography in two patients in the prone position. JA Clin Rep 9, 82 (2023).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: