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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PEEP 4 | Active Comparator | We titrate peep, using tomography impedance, making ultrasound after "level by level' of peep. After titrated peep we setup peep 4 and maintained during the procedure.
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| PEEP TITRATED | Experimental | We titrate peep, using tomography impedance, making ultrasound after "level by level' of peep. After tritiated peep we setup the best peep for less collapse (using the tomography of electrical impedance) and maintained during the procedure.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PEEP TITRATED | Procedure | After titrated peep levels, we choice this level of peep for de group (peep titrated) |
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| Measure | Description | Time Frame |
|---|---|---|
| Hyperdistension | We acquire lung ultrasound images during tritiating peep and analyze if any patient have hyperdistension | during tritiate peep |
| Measure | Description | Time Frame |
|---|---|---|
| Atelectasis | After the procedure we analyze with patient group have more atelectasis | in the final of the procedure |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Maria Jose Carmona, PhD | University of Sao Paulo | Study Chair |
| Claudia Simões, PhD | Universiadde de São Paulo/ ICESP | Study Director |
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| ID | Term |
|---|---|
| D001261 | Pulmonary Atelectasis |
| D006973 | Hypertension |
| D011654 | Pulmonary Edema |
| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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| Use ultrasound | Device | We make a lung ultrasound after we setup a different level of PEEP |
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| Impedance tomography | Device | We use the impedance tomography to titrate peep levels, and acquire dates of collapse, hyperdistension and compliance. |
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| Best PEEP for less collapse | Other | After titrated PEEP levels we setup the best PEEP the according of tomography impedance |
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| PEEP 4 | Other | We set the peep level after titrated peep = 4 cmH20. |
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