Determination of optimal PEEP and evolution of pulmonary function by electrical impedance tomography (EIT) during the intraoperative period of elective surgery

• Grant number: 13/04059-0
• Support Opportunities: Regular Research Grants
• Duration: February 01, 2014 - November 30, 2016
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Marcelo Britto Passos Amato
• Grantee: Marcelo Britto Passos Amato
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated researchers: Joaquim Edson Vieira ; Luiz Marcelo Sá Malbouisson ; Mauro Roberto Tucci

Abstract

Pulmonary atelectasis is commonly developed during general anesthesia and mechanical ventilation which can cause adverse consequences either intraoperatively or postoperatively. The use of physiological tidal volume (6-8 ml/Kg of ideal body weight) during the intraoperative period to minimize the risk of lung injury is associated with increased amount of atelectasis. The use of PEEP can prevent the formation of atelectasis and minimize the risk of complications, but at the present time, there is no way to make an optimal adjustment of PEEP for the needs of each patient.The aim of this study is to evaluate the use of Electrical Impedance Tomography (EIT), a portable monitor that enables the analysis of lung function in a continuous mode, as a tool for adjusting the PEEP in the intraoperative period using a PEEP titration procedure, and also assess the evolution of pulmonary function during this period. Forty adult patients (> 18 years) of both sexes will be studied randomly and prospectively. After anesthesia induction and neuromuscular blockage, they will be ventilated with inspired oxygen fraction of 60% (or greater in order to maintain SpO2 > 96%), tidal volume of 8 mL/Kg and respiratory rate to maintain an ETCO2 of 35 cmH2O. The patients will be assigned to two types of ventilatory strategy: (1) PEEP chosen by a PEEP titration procedure using the EIT to check the smallest value of PEEP that determines small degree of atelectasis and minimum degree of overdistension; (2) PEEP adjusted in 3 cmH2O. All patients will have its global and regional pulmonary mechanics monitored by EIT throughout the anesthetic procedure to assess the degree of pulmonary atelectasis. After the end of anesthesia and extubation, patients will be referred to the Radiology Department for a chest CT. (AU)

Scientific publications

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

PEREIRA, SERGIO M.; TUCCI, MAURO R.; MORAIS, CAIO C. A.; SIMOES, CLAUDIA M.; TONELOTTO, BRUNO F. F.; POMPEO, MICHEL S.; KAY, FERNANDO U.; PELOSI, PAOLO; VIEIRA, JOAQUIM E.; AMATO, MARCELO B. P.. Individual Positive End-expiratory Pressure Settings Optimize Intraoperative Mechanical Ventilation and Reduce Postoperative Atelectasis. ANESTHESIOLOGY, v. 129, n. 6, p. 1070-1081, DEC 2018. (13/04059-0)