Respiratory therapists' perceptions of electrical impedance tomography in pediatric intensive care: A mixed methods implementation study.

Background: The implementation of electrical impedance tomography (EIT) in pediatric critical care remains relatively new. Pediatric physiology and critical care differ substantially from adult approaches; tailored guidance and strategies are needed. This study aims to understand respiratory therapists' perspectives on integrating EIT in a quaternary pediatric critical care setting. Methods: A convergent mixed-methods study of EIT implementation was carried out over 13 months at a quaternary pediatric critical care unit, during which clinical EIT use was monitored. Participants were respiratory therapists who had completed EIT training. Two cycles of implementation and evaluation, guided by the Knowledge-to-Action Framework, were completed. Perceived workload and usability (NASA-TLX and System Usability Scale [SUS], respectively) were assessed at the start and end of the study, and clinical use was recorded. Interviews were conducted with participants at two points to tailor implementation; the interview transcripts were analyzed qualitatively to identify barriers and facilitators to implementation. Results: Fourteen respiratory therapists participated in the study. EIT was used for 32 assessments during the study period. The most common reason for using EIT was to assess PEEP. NASA-TLX and SUS indicated a moderately demanding workload and marginally low usability (46.1 and 58.0, respectively), with no statistically significant change over the study period (end-of-study scores 40.7 and 56.8, respectively). The implementation of EIT was shaped by dynamics at different levels: at the individual level, by professional identity and legitimacy; at the organizational level, by capacity and workflow realities; and at the system level, by structural integration and standardization. Adoption was not based on skepticism of EIT technology but rather on whether its perceived clinical value outweighed the capacity and workflow realities of embedding it into management. Conclusion: EIT implementation remains challenging, with individual, organizational, and system-level challenges. Infrequent use of the technology, coupled with complex interpretation, underscores the need for ongoing education to sustain user comfort, with resources and time as key factors.