{"paper_id":"042e15fe-071b-4f94-8b01-9a436f394f8f","body_text":"Predictive value of the electrical impedance tomography-derived COVmax for weaning outcomes and 60-day mortality in mechanically ventilated patients: A single-center retrospective pilot study of 43 patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predictive value of the electrical impedance tomography-derived COVmax for weaning outcomes and 60-day mortality in mechanically ventilated patients: A single-center retrospective pilot study of 43 patients Guanshuai Chen, Qijun Mo, Tiantian Lou, Fanxiang Chen, Weijie Lai, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8270582/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background To evaluate the prognostic performance of an electrical impedance tomography (EIT)-derived parameter—the maximum center of ventilation (COVmax)—for predicting weaning outcomes from invasive mechanical ventilation (IMV) and 60-day mortality in critically ill adults. Methods In this single-center retrospective cohort (December 2023–August 2025), 43 adults receiving IMV were included. EIT monitoring yielded the center of ventilation (COV) and global inhomogeneity (GI) indices. Associations between EIT parameters and (1) weaning outcome and (2) 60-day survival status were examined using binary logistic regression and Cox proportional hazards models, respectively. Multivariable models were adjusted separately for age, Charlson Comorbidity Index (CCI), and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Discrimination was assessed with receiver operating characteristic (ROC) analysis, including time-dependent ROC curve analysis for mortality. Results COVmax independently predicted both weaning failure and 60-day mortality. After adjustment for age, CCI, and APACHE II score, each 1-unit increase in COVmax was associated with lower odds of successful weaning (OR 0.86; 95% CI 0.75–0.99) and a higher risk of death at 60 days (HR 1.133; 95% CI 1.039–1.236). For the weaning outcome, the area under the curve (AUC) for COVmax combined with age was 0.687. In the time-dependent ROC curve analysis, the COVmax-plus-age model achieved an AUC of 0.754 for 60-day mortality. Conclusions EIT-derived COVmax is an independent predictor of weaning failure and 60-day mortality in mechanically ventilated patients. A higher COVmax suggests a compensatory shift of ventilation toward dependent (dorsal) lung regions, potentially reflecting severe underlying parenchymal disease. These pilot data support further large-scale prospective validation of COVmax as a prognostic marker in IMV and its integration into multimodal risk stratification. Trial registration This is a single-center, retrospective, observational study. As such, it did not require registration in a public clinical trials registry. The study protocol was approved by the Institutional Ethics Committee of Dongguan Hospital of Traditional Chinese Medicine (Approval No: SL [2025] 134). electrical impedance tomography mechanical ventilation weaning mortality prognostic prediction Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 23 Jan, 2026 Reviewers agreed at journal 14 Jan, 2026 Reviewers invited by journal 06 Jan, 2026 Editor invited by journal 10 Dec, 2025 Editor assigned by journal 08 Dec, 2025 Submission checks completed at journal 08 Dec, 2025 First submitted to journal 03 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8270582\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":570976488,\"identity\":\"d1c8dfd0-9f4c-46a1-beb8-77196e7dfe1d\",\"order_by\":0,\"name\":\"Guanshuai Chen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Dongguan Hospital of Traditional Chinese Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Guanshuai\",\"middleName\":\"\",\"lastName\":\"Chen\",\"suffix\":\"\"},{\"id\":570976495,\"identity\":\"3472735c-1249-480e-8c21-1f2c7285fc71\",\"order_by\":1,\"name\":\"Qijun 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patients\",\"fulltext\":[],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":false,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":true,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":true,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-pulmonary-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"pulm\",\"sideBox\":\"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/pulm/default.aspx\",\"title\":\"BMC Pulmonary Medicine\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"electrical impedance tomography, mechanical ventilation, weaning, mortality, prognostic prediction\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8270582/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8270582/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eTo evaluate the prognostic performance of an electrical impedance tomography (EIT)-derived parameter\\u0026mdash;the maximum center of ventilation (COVmax)\\u0026mdash;for predicting weaning outcomes from invasive mechanical ventilation (IMV) and 60-day mortality in critically ill adults.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eIn this single-center retrospective cohort (December 2023\\u0026ndash;August 2025), 43 adults receiving IMV were included. EIT monitoring yielded the center of ventilation (COV) and global inhomogeneity (GI) indices. Associations between EIT parameters and (1) weaning outcome and (2) 60-day survival status were examined using binary logistic regression and Cox proportional hazards models, respectively. Multivariable models were adjusted separately for age, Charlson Comorbidity Index (CCI), and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Discrimination was assessed with receiver operating characteristic (ROC) analysis, including time-dependent ROC curve analysis for mortality.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eCOVmax independently predicted both weaning failure and 60-day mortality. After adjustment for age, CCI, and APACHE II score, each 1-unit increase in COVmax was associated with lower odds of successful weaning (OR 0.86; 95% CI 0.75\\u0026ndash;0.99) and a higher risk of death at 60 days (HR 1.133; 95% CI 1.039\\u0026ndash;1.236). For the weaning outcome, the area under the curve (AUC) for COVmax combined with age was 0.687. In the time-dependent ROC curve analysis, the COVmax-plus-age model achieved an AUC of 0.754 for 60-day mortality.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eEIT-derived COVmax is an independent predictor of weaning failure and 60-day mortality in mechanically ventilated patients. A higher COVmax suggests a compensatory shift of ventilation toward dependent (dorsal) lung regions, potentially reflecting severe underlying parenchymal disease. These pilot data support further large-scale prospective validation of COVmax as a prognostic marker in IMV and its integration into multimodal risk stratification.\\u003c/p\\u003e\\u003ch2\\u003eTrial registration\\u003c/h2\\u003e \\u003cp\\u003eThis is a single-center, retrospective, observational study. As such, it did not require registration in a public clinical trials registry. 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