Background: The heterogeneity of pulmonary ventilation (V), perfusion (Q) and V/Q matching impairs gas exchange in an acute lung injury (ALI). This study investigated the feasibility of electrical impedance tomography (EIT) to assess the V/Q distribution and matching during an endotoxinaemic ALI in pigs. Methods: Mechanically ventilated, anaesthetised pigs (n=11, weight 30-36 kg) were studied during an infusion of endotoxin for 150 min. Impedance changes related to ventilation (ZV) and perfusion (ZQ) were monitored globally and bilaterally in four regions of interest (ROIs) of the EIT image. The distribution and ratio of ZV and ZQ were assessed. The alveolar-arterial oxygen difference, venous admixture, fractional alveolar dead space and functional residual capacity (FRC) were recorded, together with global and regional lung compliances and haemodynamic parameters. Values are mean±standard deviation (SD) and regression coefficients. Results: Endotoxinaemia increased the heterogeneity of ZQ but not Z V. Lung compliance progressively decreased with a ventral redistribution of ZV. A concomitant dorsal redistribution of Z Q resulted in mismatch of global (from ZV/ZQ 1.1±0.1 to 0.83±0.3) and notably dorsal (from ZV/Z Q 0.86±0.4 to 0.51±0.3) V and Q. Changes in global ZV/ZQ correlated with changes in the alveolar-arterial oxygen difference (r2=0.65, P<0.05), venous admixture (r 2=0.66, P<0.05) and fractional alveolar dead space (r 2=0.61, P<0.05). Decreased end-expiratory ZV correlated with decreased FRC (r2=0.74, P<0.05). Conclusions: EIT can be used to assess the heterogeneity of regional pulmonary ventilation and perfusion and V/Q matching during endotoxinaemic ALI, identifying pivotal pathophysiological changes.