Summary

A 2-year-old boy with severe pulmonary Langerhans cell histiocytosis presented in extreme respiratory failure. He was intubated and ventilated. Despite maximal support, he deteriorated and needed extremely high ventilator pressures. An electrical impedance tomography monitor was used to inform management. This is a monitoring technique which is not used in children due to the lack of suitable interface devices and a lack of randomised clinical evidence. Despite technical difficulties, a good signal was achieved. This informed management and enabled the selection of a suitable ventilator strategy, facilitating weaning. Electrical impedance tomography is a viable technology for use in paediatric critical respiratory failure. This is a non-invasive and safe technology which adds individual patient information which is not available through any other modalities. We urge equipment manufacturers to develop belts which will allow routine application of this life-saving technology in children.