Electrical Impedance Tomography-Guided Precision Nursing in an Older Patient With Septic Shock and ARDS: A Case Report.

Abstract

Septic shock complicated by acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) presents a fundamental therapeutic conflict: shock demands aggressive fluid resuscitation, whereas lung protection requires fluid restriction and a negative fluid balance. We report the precision nursing management of a 79-year-old patient with septic shock, ARDS and MODS who received invasive mechanical ventilation and continuous renal replacement therapy (CRRT). A closed-loop 'monitoring-decision-intervention' strategy was built around electrical impedance tomography (EIT): EIT-guided positive end-expiratory pressure (PEEP) titration optimised respiratory support; during CRRT fluid management, continuous EIT monitoring of ventilation distribution provided early safety warnings regarding lung ventilation; EIT-based position titration established the 45° left lateral decubitus as the optimal ventilation position; real-time EIT imaging localised airway secretions to guide targeted postural drainage; and a prevention protocol for EIT electrode belt-related pressure injuries was implemented. After 10 days of intervention, the PaO2/FiO2 ratio increased from 150 to 356 mmHg, and the patient was successfully weaned and extubated. This case suggests that EIT-guided precision nursing may help balance fluid management with lung protection and provide visual guidance for airway clearance and position management; its effectiveness warrants validation in prospective studies. This case provides a reproducible, nurse-led framework that integrates EIT ventilation monitoring to reconcile competing treatment goals in septic shock complicated by ARDS, offering a practical reference for complex critical care nursing.