BackgroundDuring protective mechanical ventilation, electrical impedance tomography (EIT) is used to monitor alveolar recruitment maneuvers as well as the distribution of regional ventilation. This technique can infer atelectasis and lung overdistention during mechanical ventilation in anesthetized patients or in the ICU. Changes in lung tissue stretching are evaluated by monitoring the electrical impedance of lung tissue with each respiratory cycle.ObjectiveThis study aimed to evaluate the distribution of regional ventilation during recruitment maneuvers based on the variables obtained in pulmonary electrical impedance tomography during protective mechanical ventilation, focusing on better lung recruitment associated with less or no overdistention.MethodsProspective clinical study using seven adult client–owned healthy dogs, weighing 25 ± 6 kg, undergoing elective ovariohysterectomy or orchiectomy. The animals were anesthetized and ventilated in volume-controlled mode (7 ml.kg−1) with stepwise PEEP increases from 0 to 20 cmH2O in steps of 5 cmH2O every 5 min and then a stepwise decrease. EIT, respiratory mechanics, oxygenation, and hemodynamic variables were recorded for each PEEP step.ResultsThe results show that the regional compliance of the dependent lung significantly increased in the PEEP 10 cmH2O decrease step when compared with baseline (p < 0.027), and for the nondependent lung, there was a decrease in compliance at PEEP 20 cmH2O (p = 0.039) compared with baseline. A higher level of PEEP was associated with a significant increase in silent space of the nondependent regions from the PEEP 10 cmH2O increase step (p = 0.048) until the PEEP 15 cmH2O (0.019) decrease step with the highest values at PEEP 20 cmH20 (p = 0.016), returning to baseline values thereafter. Silent space of the dependent regions did not show any significant changes. Drive pressure decreased significantly in the PEEP 10 and 5 cmH2O decrease steps (p = 0.032) accompanied by increased respiratory static compliance in the same PEEP step (p = 0.035 and 0.018, respectively).ConclusionsThe regional ventilation distribution assessed by EIT showed that the best PEEP value for recruitment maintenance, capable of decreasing areas of pulmonary atelectasis in dependent regions promoting less overinflation in nondependent areas, was from 10 to 5 cmH2O decreased steps.
Long bone fractures are common in small ruminants, and has been described some methods of osteosynthesis. The external fixator is considered a good option because it is non-invasive method and does not cause significant damage to adjacent tissue and vascularization. A goat, female, three months old, it was referred to the Veterinary Hospital with functional impotence of the thoracic left limb. It was diagnosed incomplete and transverse fracture of the third portion of the ulna, associated a lateroproximal luxation between radio and ulna. After a conservative treatment, the animal was forwarded to surgery procedure. The fracture was reduced manually and osteosynthesis was performed with external fixator type I using seven transcortical pins in lateral direction, that were fixed with methacrylate molded in plastic tube. Fifteen days after surgery was observed flexural deformity of the affected limb. This was fixed with placement splint for 15 days. After radiographic control and bone regeneration, the external fixator was removed after 45 days from surgery. The animal was discharge 51 days after removal the implant with a good weight bearing
BackgroundElectrical impedance tomography (EIT) has been an essential tool for assessing pulmonary ventilation in several situations, such as the alveolar recruitment maneuver (ARM) in PEEP titration to maintain the lungs open after atelectasis reversion. In the same way as in humans and dogs, in horses, this tool has been widely used to assess pulmonary aeration undergoing anesthesia, mechanical ventilation, recruitment maneuver, standing horses, or specific procedures.ObjectivesThe present study aimed to evaluate the distribution of regional ventilation during ARM based on lung monitoring assessment by EIT, with a focus on better recruitment associated with less or no overdistention.MethodsFourteen horses of 306 ± 21 kg undergoing isoflurane anesthesia in dorsal recumbency were used. The animals were mechanically ventilated with a tidal volume of 14 ml kg−1 and a respiratory rate of 7–9. An alveolar recruitment maneuver was instituted, increasing the PEEP by five cmH2O every 5 min until 32 cmH2O and decreasing it by five cmH2O every 5 min to 7 cmH2O. At each step of PEEP, arterial blood samples were collected for blood gas analysis, EIT images, hemodynamic, and respiratory mechanics.ResultsAssociated with the CoV-DV increase, there was a significant decrease in the DSS during the ARM and a significant increase in the NSS when PEEP was applied above 12 cmH2O compared to baseline. The ComplROI showed a significant increase in the dependent area and a significant decrease in the non-dependent area during ARM, and both were compared to their baseline values. The driving pressure decreased significantly during the ARM, and Cst, PaO2, and PaO2/FiO2 ratio increased significantly. The VD/VT decreased significantly at DEPEEP17 and DEPEEP12. There was an HR increase at INPEEP27, INPEEP 32, and DEPEEP17 (p < 0.0001; p < 0.0001; and p < 0.05, respectively), those values being above the normal reference range for the species. The SAP, MAP, DAP, CI, and DO2I significantly decreased INPEEP32 (p < 0.05).ConclusionThe ARM by PEEP titration applied in the present study showed better ventilation distribution associated with better aeration in the dependent lung areas, with minimal overdistention between PEEP 17 and 12 cmH2O decreasing step. Those changes were also followed by improvements in static and regional compliance associated with increased oxygenation and pulmonary ventilation. ARM promoted a transitory decrease in arterial blood pressure and depression in CI with a concomitant drop in oxygen delivery, which should be best investigated before its routine use in clinical cases.
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