Bedside quantification of the alveolar recruitment potential using electrical impedance tomography in an experimental model of acute respiratory distress syndrome.

• Grant number: 11/13861-9
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)
• Start date: March 01, 2012
• End date: July 31, 2013
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Marcelo Britto Passos Amato
• Grantee: Roberta Ribeiro de Santis Santiago
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Introduction: The protective ventilator strategy is fundamental in the treatment of the acute respiratory distress syndrome (ARDS) associated or not with a recruitment maneuver (RM). Computed tomography (CT) is the golden standard to assess the recruitment potential (RP).The CT application is limited: dislocating of an instable patient and the exposure to radiation. Measures of oxygenation and ventilatory mechanisms are not able to demonstrate regional imbalances on lung ventilation.The Electrical Impedance Tomography (EIT) is a device capable of monitoring changes in regional pulmonary ventilation. Objectives:1)In an ARDS experimental model, to correlate the recruited alveoli percentage after a " testing RM"(PEEP of 20cmH2O and inspiratory plateau of 30 cmH2O with the percentage of recruited alveoli after the application of a "maximum RM" (with inspiratory pressure up to 60cmH2O);2) To compare the quantification of the RP informed by the TIE with the one offered by the ultrasound(US) and CT;3)To compare the EIT(regional compliance variations- the quantification of the of alveolar units added to the functioning pool) with the shunt variations during the RMs ; 4)To develop an EIT tool able to calculate online the RP based on the "testing RM". Preliminary results (4 pilots): we have found correlation among the shunt values and the collapse calculated by the EIT (r2=0,73 and p<0,0001) during the RMs. We compared the percentage of recruitment during the first step ("safe one") with the last one ("maximum one") and we have found correlation (r2=0,92 and p<0,002).Keywords: Acute respiratory distress syndrome, alveolar recruitment, recruitment maneuver, mechanical ventilation, electrical impedance tomography, pulmonary shunt , pulmonary compliance.

Academic Publications

(References retrieved automatically from State of São Paulo Research Institutions)

SANTIAGO, Roberta Ribeiro de Santis. Bedside quantification of alveolar recruitment potential using electrical impedance tomography in an experimental model of acute respiratory distress syndrome. 2016. Doctoral Thesis - Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD) São Paulo.