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 PaO ₂ /FiO ₂ 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.