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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

Adapted from Adler. J Appl Physiol 1997

Patient thoraxPatient thorax

amplifiers

Imaging system

+

+

+-

-

-

Electrical Impedance TomographyElectrical Impedance Tomography

Acquisition

controller

+

- V2V1

V3...

Vn

+-

V2

V1

V3...

Vn

+ -

V2

V1

V3...

Vn

+-

V2

V1

V3...

Vn

+

-

V2

V1V3...

Vn

+

-

V2V1V3...

Vn

+

-V2 V1

V3...

Vn

+-V2

V1

V3...

Vn

+-

V2

V1

V3...

Vn

+

-

V2V1

V3...

Vn

+

-

V2V1 V3...

Vn

LIM 09

Hospital das Clínicas - FMUSP

Laboratório de Investigação Médica em Pneumologia – LIM 09

Reg 1Reg 1

Reg 2Reg 2

Reg 3Reg 3

Reg 4Reg 4

URUR ULUL

LRLR LLLL

7.5

5.0

2.5

0

Z

(%)

Changes in Air content (mL)

Selective intubationSelective intubation

SPECT

PneumothoraxPneumothorax

Costa 2006. Submetido à publicação.

Costa 2006. Submetido à publicação

Mapa de mudança de aeração local

BasalBasal 100 mL100 mL

Mapa de mudança de aeração local

Costa et al. 2006 - submitted

100

mL

100

mL

Bas

alB

asal

Pneumothorax detector

• sensitivity 100%sensitivity 100%• specificity 95%specificity 95%

Costa 2006. Submetido à publicação

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

Collapse:

55.6 %55.6 %

PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia

FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 55 cmHcmH22OO

FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 25 25 cmHcmH22OO( after recruitment maneuver )( after recruitment maneuver )

Collapse:

0.9 %0.9 %


FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 25 25 cmHcmH22OO

Collapse:

0.9 %0.9 %



Collapse:

0.6 %0.6 %



Collapse:

1.0 %1.0 %



Collapse:

5.5 %5.5 %



Collapse:

12.4 %12.4 %



Collapse:

22.3 %22.3 %



Collapse:

55.6 %55.6 %


Laboratório de Investigação Médica em Pneumologia – LIM 09

PEEP = 19 cmH2O

PEEP = 13 cmH2O

EIT func. imageEIT func. image

PEEP = 10PEEP = 10 PEEP = 0PEEP = 0

Titulação da PEEP

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

PEEP = 23.5PEEP = 23.5

PEEP = 23.5PEEP = 23.5

PEEP = 21.5PEEP = 21.5

PEEP = 23.5PEEP = 23.5

PEEP = 21.5PEEP = 21.5

PEEP = 19.4PEEP = 19.4

PEEP = 23.5PEEP = 23.5

PEEP = 21.5PEEP = 21.5

PEEP = 19.4PEEP = 19.4

PEEP = 17.2PEEP = 17.2

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

PEEP = 11.5PEEP = 11.5

PEEP = 11.5PEEP = 11.5

PEEP = 9.5PEEP = 9.5


PEEP = 11.5PEEP = 11.5




SUPINE

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

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

BronchoscopyBronchoscopy

Diffuse injury

PEEP: 13 Cdyn: - 3.6




-8.1%

PaO2

Focal injury


PEEP: 15 Cdyn: - -13.8

PEEP: 17 Cdyn: - 17.0

PEEP: 19 Cdyn: - 27.4

-27.4%

PaO2

Diffuse

Localized

CT: - 200 HU to 100 HU

510152025

0

10

20

30

40

50

60

-10

% o

f col

laps

ed u

nits

EIT

CT

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)

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