Pulmonary Evaluation With Ultrasound in Different Levels of PEEP

Summary

Patients submitted to general anesthesia and artificial ventilation almost always develop pulmonary atelectasis, which can determine adverse consequences both intraoperatively and postoperatively. It is recommended to use physiological tidal volume (6 - 8 mL / kg of ideal body weight) during the intraoperative period in order to minimize the risk of lung injury. To prevent the formation of atelectasis, minimizing the risk of complications, the use of PEEP has been recommended. At present, there is no way to make an optimal adjustment of PEEP to the needs of each patient, seeking a value that keeps the alveoli open without forming atelectasis and also without areas of hyperdistension.

The aim of this study was to evaluate the agreement between the ultrasound and the electrical impedance tomography - Timpel® (TIE) to detect the beginning of the formation of areas of atelectasis after pulmonary recruitment, with decreasing PEEP values. In addition, the lung ultrasound will be validated for intraoperative use for both adequacy of PEEP, as well as quantitative analyzes of ultrasound images to assess atelectasis.

18 patients (\> 18 years) of both sexes, submitted to general anesthesia, will be prospectively studied. All patients will receive, in addition to the usual monitoring, the monitoring with the electrical impedance tomography and chest ultrasonography, after being anesthetized and under neuromuscular block, being ventilated with an inspired fraction of 50% oxygen (or greater to maintain oxygen saturation \> 96% ), Tidal volume of 6 mL / kg and respiratory rate to maintain expiratory tidal CO2 between 35-45 cmH2O.

Conditions

• Atelectasis
• Hypertension
• Lung Edema

Interventions

PROCEDURE

PEEP TITRATED

After titrated peep levels, we choice this level of peep for de group (peep titrated)

DEVICE

Use ultrasound

We make a lung ultrasound after we setup a different level of PEEP

DEVICE

Impedance tomography

We use the impedance tomography to titrate peep levels, and acquire dates of collapse, hyperdistension and compliance.

OTHER

Best PEEP for less collapse

After titrated PEEP levels we setup the best PEEP the according of tomography impedance

OTHER

PEEP 4

We set the peep level after titrated peep = 4 cmH20.

Sponsors & Collaborators

• Instituto do Cancer do Estado de São Paulo

  lead OTHER

Principal Investigators

• Maria Jose Carmona, PhD · University of Sao Paulo

• Claudia Simões, PhD · Universiadde de São Paulo/ ICESP

Study Design

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

30 Years

Max Age

60 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2015-12-15

Primary Completion

2017-02-15

Completion

2017-04-15