Fisiopatología de la respuesta en el shock · Ecografia Pulmonar: No es Posible Medicina de...

RECLUTAMIENTO PULMONAR ¿TIENE UN ROL LA ECOGRAFÍA?

Dr. Pablo Bravo F.

Winfocus Member

Unidad Paciente Crítico Pediátrico, Hospital San Juan de Dios,

Santiago, Chile

Ecografia Pulmonar: No es Posible

Medicina de Harrison ( 17º

edición )

“ Ya que los ultrasonidos se

disipan rápidamente en el aire,

la ecografía no es útil en la

evaluación del parénquima

pulmonar “

Ecografia Pulmonar: Si es Posible

Ecografia Pulmonar: Si es Posible

Intensive Care Med (2012) 38:577–591

Ecografía Pulmonar

Intensive Care Med (2014) 40:1592–1594

Artefactos Pulmonares - Imágenes

J Ultrasound Med 2009; 28:163–174

Cardiovascular Ultrasound 2008, 6:16

HETEROGENEO HOMOGENEO

Anesthesiology. 2015 Feb;122(2):437-47

Patrones Ultasonograficos Pulmonares Normal

Sindrome Intersticial

Sindrome Alveolo - Intersticial

Condensación

Condensación

Crit Care Med 2007; 35:2769–2774)

Crit Care Med 2007; 35:2769–2774)

Am J Respir Crit Care Med Vol 183. pp 341–347, 2011

Am J Respir Crit Care Med Vol 183. pp 341–347, 2011

Am J Respir Crit Care Med Vol 183. pp 341–347, 2011

Am J Respir Crit Care Med Vol 183. pp 341–347, 2011

Respir Care 2015;60(5):e93–e96

M.S.A., a 3-month-old white female, was admitted to

the PICU of our hospital, under the diagnosis of syncytial

virus bronchiolitis, requiring invasive mechanical ventilation.

After 5 days, because the infant presented fever and right

pulmonary infiltrate, antibiotic therapy was initiated. Then, the

patient developed severe hypoxemia needing increased ventilatory

support with peak inspiratory pressure set at 32 cmH2 O,

mean airway pressure at 20 cmH2 O, PEEP at 12 cmH2 O, The

baseline ventilator settings were pressure-controlled

cycling, mean airway pressure set at 20 cmH2 O, PEEP at 12

cmH2 O, ventilation rate kept at 20 breaths per minute, inspiratory

time at 0.7 seconds, and FIO2 at 85%.

Ultrasound Quarterly 2014;30:301Y305)

Ultrasound Quarterly 2014;30:301Y305)

Intensive Care Med. 2016 Oct;42(10):1546-56

Intensive Care Med. 2016 Oct;42(10):1546-56

J Crit Care. 2016 Apr;32:36-41

J Crit Care. 2016 Apr;32:36-41

Tusman et al. Crit Ultrasound J (2016) 8:8

conclusiones

• LUS was compared with the PV curve method, a technique that

is tightly correlated to lung CT for measuring PEEP-induced

lung recruitment

• Therefore, the ultrasound reaeration score could be

appropriate for measuring recruitment resulting from any

treatment aimed at increasing lung aeration, such as PEEP,

negative fluid balance, positioning , or recruitment maneuvers.

In addition, the statistically significant correlation existing

between the LUS reaeration score and the PEEPinduced

increase in PaO2 indirectly confirms that LUS accurately

detects PEEP-induced lung recruitment.

Am J Respir Crit Care Med Vol 183. pp 341–347, 2011

www.winfocus2017.com

Email: pebravo@uc.cl