diagnosis of acute dyspnea.课件

CarmenValenteBarbasHOSPITALDASCL NICASFACULDADEDEMEDICINAUNIVERSIDADEDES OPAULOEUTI ADULTOSHOSPITALISRAELITAALBERTEINSTEIN APLICA ESDATOMOGRAFIACOMPUTADORIZADADET RAXEMVENTILA OMEC NICA ASPIRA OHIPOVENTILA O ATELECTASIAOBSTRU ODEVIASA REASSUPERIORESBRONCOESPASMOPNEUMONIASEPSETEPCONGEST O ARRITMIA HIPOXEMIA TOMOGRAFIADET RAXPROTOCOLOTEP Analysisof100MultisliceThoracicAngiotomographyintheDiagnosisofAcuteDyspnea TRLara MD HBBogosian MD FNDCampos MD GFJMatos MD PhD ECMeyer MD PhD MFunari MD PhDandCSVBarbas MD PhD AlbertEinsteinHospitalThoracicAngiotomographyStudyGroup S oPaulo Brazil 100angiotomografiasdeT raxProtocoloTEP julhoaoutubrode2008 34Homens 66mulheres idadem dia 63 19anos 13 90 2pacientescomoclus odeart riaprincipale5oclus esdeart riaslobares21pacientesoclus essegmentares 10dosquaismultisegmentares65 dospacientesapresentavamaltera odopar nquimapulmonarSinaisdeatelectasiasem53 derramepleuralem41 eTEPem28 ARDSANDMECHANICALVENTILATION HYPERDISTENTION COLLAPSEANDREOPENING VILI VILI ThoracicTomographyandInspiratoryandExpiratoryPxVcurve LungrecruitmentmanueversinARDS BarbasCSV MatosGFJ OkamotoV BorgesJB AmatoMBP CarvalhoCRR RespirCareClinNorthAm 2003 9 4 401 418 ReversibilityofLungCollapseandHypoxemiainEarlyAcuteRespiratoryDistressSyndrome BorgesJB OkamotoVN MatosGJF CaramezMP ArantesPRR BarrosF SouzaCE VictorinoJA KacmarekRM BarbasCSV CarvalhoCRR AmatoMBP AmJRespirCritCareMed 2006 PEEP 5cmH2OCollapsearea 54 3 Collapsemass 69 2 PEEP 19cmH2O Pflex 2cmH2O Collapsearea 21 9 Collapsemass 36 8 PEEP 25cmH2O afterPPLAT 55cmH2O Collapsearea 0 4 Collapsemass 0 9 MORTALITY 28 45PACIENTES APACHEII 20 6 Maximalrecruitmentpressure 60 0 5 0 TitratedPEEP 24 2 3 5 PaO2 FIO2preandpost 130 43317 99 MaximalrecruitmentStrategyguidedbyThoracicCTscanininsevereacuterespiratorydistresssyndrome acaseseriesreport MatosGJF BorgesJB PassosRH MeyerEC HoelzC RodriguesM CarvalhoCRR AmatoMBP BarbasCSV CriticalCare 2007 11 2 S76 ARDSPROTOCOL STEPWISEPEEPINCREMENTRECRUIMENTMANUEVERWITHFIXPRESSURECONTROLVENTILATIONANDPEEPADJUSTMENTATTHORACICTOMOGRAPH MatosGJF BorgesJB PassosRH MeyerEC HoelzC RodriguesM CarvalhoCRR AmatoMBP BarbasCSV CriticalCare 2007 11 2 S76 PEEP 10cmH20 EXPIRATION 43years old PaO2 FIO2 134 Nosocomialpneumonia malariaAPACHEII 11 SOFA 13 FONP 2 24hsinstallation shock PEEP 10cmH20 PCV 15 INSPIRATION PEEP 45cmH20 EXPIRATION PEEP 45cmH20 PCV 15 INSPIRATION PEEP 25cmH20 EXPIRATION PEEP 25cmH20 PCV 15 INSPIRATION 43years old PaO2 FIO2pre 134PaO2 FIO2post 391 EXPIRATION INSPIRATION PCV 15 PEEP 10cmH20 PEEP 45cmH20 PEEP 25cmH20 PaO2 FIO2 62 PaO2 FIO2 349 64years old PaO2 FIO2 62 aspirationAPACHEII 18 SOFA 7 FONP 1 24hsinstallation shock EXPIRATION INSPIRATION PCV 15 PEEP 10cmH20 PEEP 45cmH20 PEEP 25cmH20 PaO2 FIO2 194 PaO2 FIO2 365 35years old PaO2 FIO2 194 Alveolarhemorrhage cocksackievirusAPACHEII 22 SOFA 9 FONP 2 24hsinstallation EXPIRATION INSPIRATION PCV 15 PEEP 10cmH20 PEEP 45cmH20 PEEP 25cmH20 PaO2 FIO2 170 PaO2 FIO2 397 23years old PaO2 FIO2 170 gastricaspirationAPACHEII 16 SOFA 6 FONP 1 24hsinstallation shock MEAN SEM n 12 MEAN SEM n 12 MEAN SEM n 12 MEAN SEM n 12 STRAIN TENSIONELASTICTISSUE MEAN SEM n 12 MatosGJF BorgesJB PassosRH MeyerEC HoelzC RodriguesM CarvalhoCRR AmatoMBP BarbasCSV CriticalCare 2007 11 2 S76 45patients meanage 49 6 16 7years82 primaryARDSTitratedpeep 24 18 3 44 Maxplateau 39 98 4 84APACHEII 19 20 7 10 SOFAscore 9 58 3 39NPOF 1 76 1 0 SEPSIS 68 8 VASOPRESSORS 84 AcuterenalfailurewithCRRT 55 ICUSURVIVAL 73 MaximalrecruitmentStrategyguidedbyThoracicCTscaninsevereacuterespiratorydistresssyndrome acaseseriesreport IP47aALCOOLISMO PNEUMONIACOMUNIT RIAGRAVE SDRA CHOQUES PTICO PEEP10PRERM PEEP10PRERM PEEP10PRERM PRESS OM XIMARECRUTAMENTO65cm