fisiopatología de la respuesta en el shock · ecografia pulmonar: no es posible medicina de...
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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
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