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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
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Electrical Impedance TomographyElectrical Impedance Tomography
Acquisition
controller
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LIM 09
Hospital das Clínicas - FMUSP
Laboratório de Investigação Médica em Pneumologia – LIM 09
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
Costa 2006. Submetido à publicação
Mapa de mudança de aeração local
BasalBasal 100 mL100 mL
Mapa de mudança de aeração local
Mapa de mudança de aeração local
20mL
40mL
60mL
80mL
100mL
150mL
200mL
250mL
300mL
350mL
400mL
450mL
500mL
550mL
600mL
Costa et al. 2006 - submitted
100
mL
100
mL
Bas
alB
asal
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 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 25 25 cmHcmH22OO
Collapse:
0.9 %0.9 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 23 23 cmHcmH22OO
Collapse:
0.6 %0.6 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 21 21 cmHcmH22OO
Collapse:
0.6 %0.6 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 19 19 cmHcmH22OO
Collapse:
1.0 %1.0 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 17 17 cmHcmH22OO
Collapse:
5.5 %5.5 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 15 15 cmHcmH22OO
Collapse:
12.4 %12.4 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 13 13 cmHcmH22OO
Collapse:
22.3 %22.3 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
FFIIOO22 = = 100 100 %%; V; VTT = = 44 mL/kgmL/kg; PEEP = ; PEEP = 5 5 cmHcmH22OO
Collapse:
55.6 %55.6 %
PatientPatient # 9 # 9PneumocystisPneumocystiscarinii carinii pneumoniapneumonia
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 = 7.5PEEP = 7.5
PEEP = 11.5PEEP = 11.5
PEEP = 9.5PEEP = 9.5
PEEP = 7.5PEEP = 7.5
PEEP = 11.5PEEP = 11.5
PEEP = 9.5PEEP = 9.5
PEEP = 7.5PEEP = 7.5
PEEP = 5.5PEEP = 5.5
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
SUPINE
PRONE
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
PEEP: 15 Cdyn: - 6.0
PEEP: 17 Cdyn: - 6.7
PEEP: 19 Cdyn: - 8.1
-8.1%
PaO2
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
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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