Dept. of Anesthesiology footer area TC e TIE no paciente com SARA Marcelo B. P. Amato University of São Paulo Brazil III Curso Nacional de Ventilação Mecânica da SBPT São Paulo, SP

Adapted from Adler. J Appl Physiol 1997 Patient thorax amplifiers Imaging system Electrical Impedance Tomography Acquisition controller

+ - V2V2 V1V1 V 3... VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

+ - V2V2 V1V1 VnVn

LIM 09 Hospital das Clínicas - FMUSP

Laboratório de Investigação Médica em Pneumologia – LIM 09

Reg 1 Reg 2 Reg 3 Reg 4 UR UL LR LL

 Z (%) Changes in Air content (mL)

Selective intubation SPECT

Pneumothorax

Costa Submetido à publicação.

Costa Submetido à publicação

Mapa de mudança de aeração local Basal 100 mL

Mapa de mudança de aeração local

20mL

40mL

60mL

80mL

100mL

150mL

200mL

250mL

300mL

350mL

400mL

450mL

500mL

550mL

600mL

Costa et al submitted 100 mL Basal

Costa et al submitted 100 mL Basal

Pneumothorax detector sensitivity 100%sensitivity 100% specificity 95%specificity 95% Costa Submetido à publicação

Collapse: 55.6 % Patient # 9 Pneumocystis carinii pneumonia F I O 2 = 100 % ; V T = 4 mL/kg ; PEEP = 5 cmH 2 O

F I O 2 = 100 % ; V T = 4 mL/kg ; PEEP = 25 cmH 2 O ( after recruitment maneuver ) Collapse: 0.9 % Patient # 9 Pneumocystis carinii pneumonia

F I O 2 = 100 % ; V T = 4 mL/kg ; PEEP = 25 cmH 2 O Collapse: 0.9 % Patient # 9 Pneumocystis carinii pneumonia

F I O 2 = 100 % ; V T = 4 mL/kg ; PEEP = 23 cmH 2 O Collapse: 0.6 % Patient # 9 Pneumocystis carinii pneumonia

F I O 2 = 100 % ; V T = 4 mL/kg ; PEEP = 21 cmH 2 O Collapse: 0.6 % Patient # 9 Pneumocystis carinii pneumonia

F I O 2 = 100 % ; V T = 4 mL/kg ; PEEP = 19 cmH 2 O Collapse: 1.0 % Patient # 9 Pneumocystis carinii pneumonia

F I O 2 = 100 % ; V T = 4 mL/kg ; PEEP = 17 cmH 2 O Collapse: 5.5 % Patient # 9 Pneumocystis carinii pneumonia

F I O 2 = 100 % ; V T = 4 mL/kg ; PEEP = 15 cmH 2 O Collapse: 12.4 % Patient # 9 Pneumocystis carinii pneumonia

F I O 2 = 100 % ; V T = 4 mL/kg ; PEEP = 13 cmH 2 O Collapse: 22.3 % Patient # 9 Pneumocystis carinii pneumonia

F I O 2 = 100 % ; V T = 4 mL/kg ; PEEP = 5 cmH 2 O Collapse: 55.6 % Patient # 9 Pneumocystis carinii pneumonia

Laboratório de Investigação Médica em Pneumologia – LIM 09

PEEP = 19 cmH 2 O

PEEP = 13 cmH 2 O

EIT func. image

PEEP = 10 PEEP = 10 PEEP = 0 PEEP = 0 Titulação da PEEP

PEEP = 23.5

PEEP = 21.5

PEEP = 23.5 PEEP = 21.5 PEEP = 19.4

PEEP = 23.5 PEEP = 21.5 PEEP = 19.4 PEEP = 17.2

PEEP = 23.5 PEEP = 21.5 PEEP = 19.4 PEEP = 17.2 PEEP = 13.6

PEEP = 11.5

PEEP = 9.5 PEEP = 7.5

PEEP = 11.5 PEEP = 9.5 PEEP = 7.5

PEEP = 11.5 PEEP = 9.5 PEEP = 7.5 PEEP = 5.5

PEEP = 11.5 PEEP = 9.5 PEEP = 7.5 PEEP = 5.5 PEEP = 3.5

SUPINE

PRONE

ARTERIAL PO 2 (mmHg) % COLAPSED TISSUE

ARTERIAL PO 2 (mmHg) % COLAPSED TISSUE

Bronchoscopy

Diffuse injury PEEP: 13   C dyn: PEEP: 15   C dyn: PEEP: 17   C dyn: PEEP: 19   C dyn: % PaO 2

Focal injury PEEP: 13   C dyn: PEEP: 15   C dyn: PEEP: 17   C dyn: PEEP: 19   C dyn: % PaO 2

Diffuse Localized

CT: HU to 100 HU % of collapsed units EIT CT

Adjusted Arterial PO 2 (mmHg) R 2 = Percent of collapsed units (EIT analysis)