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Transcript of Dept. of Anesthesiology footer area TC e TIE no paciente com SARA Marcelo B. P. Amato University of...
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footer area
Dept. of Anesthesiology
TC e TIE no paciente com SARA
Marcelo B. P. Amato
University of São PauloBrazil
III Curso Nacional de Ventilação Mecânica da SBPT São Paulo, SP - 2008
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Adapted from Adler. J Appl Physiol 1997
Patient thoraxPatient thorax
amplifiers
Imaging system
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Electrical Impedance TomographyElectrical Impedance Tomography
Acquisition
controller
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LIM 09
Hospital das Clínicas - FMUSP
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Laboratório de Investigação Médica em Pneumologia – LIM 09
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Laboratório de Investigação Médica em Pneumologia – LIM 09
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Reg 1Reg 1
Reg 2Reg 2
Reg 3Reg 3
Reg 4Reg 4
URUR ULUL
LRLR LLLL
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7.5
5.0
2.5
0
Z
(%)
Changes in Air content (mL)
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Selective intubationSelective intubation
SPECT
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PneumothoraxPneumothorax
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Costa 2006. Submetido à publicação.
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Costa 2006. Submetido à publicação
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Costa 2006. Submetido à publicação
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Mapa de mudança de aeração local
BasalBasal 100 mL100 mL
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Mapa de mudança de aeração local
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Mapa de mudança de aeração local
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20mL
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40mL
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60mL
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80mL
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100mL
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150mL
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200mL
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250mL
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300mL
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350mL
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400mL
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450mL
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500mL
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550mL
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600mL
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Costa et al. 2006 - submitted
100
mL
100
mL
Bas
alB
asal
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Costa et al. 2006 - submitted
100
mL
100
mL
Bas
alB
asal
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Pneumothorax detector
• sensitivity 100%sensitivity 100%• specificity 95%specificity 95%
Costa 2006. Submetido à publicação
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DETECTING CLOSING PRESSURES
TIME
AIR
WA
Y P
RE
SS
UR
E (
cmH 2O
)
0
10
20
30
40
50
60
70
Blo
od G
as
Blo
od G
as
Blo
od G
as
Blo
od G
as
26 24 22 20
PEEP = 26
"Totally Open Lung "
SHUNT < 10%
Till detecting 10% fall in PaO2B
lood
Gas
18
4 min Steps
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55.6 %55.6 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 55 cmHcmH22OO
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FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 25 25 cmHcmH22OO( after recruitment maneuver )( after recruitment maneuver )
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0.9 %0.9 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
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FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 25 25 cmHcmH22OO
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0.9 %0.9 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
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FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 23 23 cmHcmH22OO
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0.6 %0.6 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
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FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 21 21 cmHcmH22OO
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0.6 %0.6 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
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FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 19 19 cmHcmH22OO
Collapse:
1.0 %1.0 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
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FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 17 17 cmHcmH22OO
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5.5 %5.5 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
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FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 15 15 cmHcmH22OO
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12.4 %12.4 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
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FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 13 13 cmHcmH22OO
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22.3 %22.3 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
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FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 5 5 cmHcmH22OO
Collapse:
55.6 %55.6 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
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Laboratório de Investigação Médica em Pneumologia – LIM 09
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PEEP = 19 cmH2O
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PEEP = 13 cmH2O
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EIT func. imageEIT func. image
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PEEP = 10PEEP = 10 PEEP = 0PEEP = 0
Titulação da PEEP
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DETECTING CLOSING PRESSURES
TIME
AIR
WA
Y P
RE
SS
UR
E (
cmH 2O
)
0
10
20
30
40
50
60
70
Blo
od G
as
Blo
od G
as
Blo
od G
as
Blo
od G
as
26 24 22 20
PEEP = 26
"Totally Open Lung "
SHUNT < 10%
Till detecting 10% fall in PaO2B
lood
Gas
18
4 min Steps
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PEEP = 23.5PEEP = 23.5
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PEEP = 23.5PEEP = 23.5
PEEP = 21.5PEEP = 21.5
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PEEP = 23.5PEEP = 23.5
PEEP = 21.5PEEP = 21.5
PEEP = 19.4PEEP = 19.4
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PEEP = 23.5PEEP = 23.5
PEEP = 21.5PEEP = 21.5
PEEP = 19.4PEEP = 19.4
PEEP = 17.2PEEP = 17.2
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PEEP = 23.5PEEP = 23.5
PEEP = 21.5PEEP = 21.5
PEEP = 19.4PEEP = 19.4
PEEP = 17.2PEEP = 17.2
PEEP = 13.6PEEP = 13.6
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PEEP = 11.5PEEP = 11.5
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PEEP = 11.5PEEP = 11.5
PEEP = 9.5PEEP = 9.5
PEEP = 7.5PEEP = 7.5
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PEEP = 11.5PEEP = 11.5
PEEP = 9.5PEEP = 9.5
PEEP = 7.5PEEP = 7.5
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PEEP = 11.5PEEP = 11.5
PEEP = 9.5PEEP = 9.5
PEEP = 7.5PEEP = 7.5
PEEP = 5.5PEEP = 5.5
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PEEP = 11.5PEEP = 11.5
PEEP = 9.5PEEP = 9.5
PEEP = 7.5PEEP = 7.5
PEEP = 5.5PEEP = 5.5
PEEP = 3.5PEEP = 3.5
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SUPINE
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PRONE
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Model Summary
.796a .634 .623 90.48631 .634 60.499 1 35 .000Model1
R R SquareAdjustedR Square
Std. Error ofthe Estimate
R SquareChange F Change df1 df2 Sig. F Change
Change Statistics
Predictors: (Constant), supinoa.
ARTE
RIAL
PO
2
(mm
Hg)
% COLAPSED TISSUE
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Model Summary
.851a .725 .717 65.60886 .725 99.966 1 38 .000Model1
R R SquareAdjustedR Square
Std. Error ofthe Estimate
R SquareChange F Change df1 df2 Sig. F Change
Change Statistics
Predictors: (Constant), pronaa.
ARTE
RIAL
PO
2
(mm
Hg)
% COLAPSED TISSUE
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BronchoscopyBronchoscopy
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Diffuse injury
PEEP: 13 Cdyn: - 3.6
PEEP: 15 Cdyn: - 6.0
PEEP: 17 Cdyn: - 6.7
PEEP: 19 Cdyn: - 8.1
-8.1%
PaO2
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Focal injury
PEEP: 13 Cdyn: - 4.7
PEEP: 15 Cdyn: - -13.8
PEEP: 17 Cdyn: - 17.0
PEEP: 19 Cdyn: - 27.4
-27.4%
PaO2
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Diffuse
Localized
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CT: - 200 HU to 100 HU
510152025
0
10
20
30
40
50
60
-10
% o
f col
laps
ed u
nits
EIT
CT
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Adj
uste
d A
rter
ial P
O2 (
mm
Hg)
R2=0.72
0 20 40 600
100
200
300
400
500
600
700
800
Percent of collapsed units (EIT analysis)