Trombólise na embolia pulmonar maciça com base na capnografia volumétrica

Abstract

Pulmonary embolism; capnography; thrombolytic therapy. This is the first report of a patient submitted to chemical thrombolysis due to massive pulmonary embolism (PE) during the postoperative period of neurosurgery, in whom due to the lack of adequate clinical conditions, no imaging assessment was performed. Clinical, gasometric and capnographic data allowed the decision to perform the thrombolysis with safety. The P(a-et)CO 2 gradient decreased from 46.4 mmHg to 11.8 mmHg (normal < 5 mmHg) and the end-tidal alveolar dead space fraction decreased from 0.85 to 0.37 (normal < 0.15) from the pre-thrombolysis period to the 7 th day postthrombolysis. We conclude that the volumetric capnography (VC) was useful in the patient's diagnosis and clinical follow-up. Thrombolysis in Massive Pulmonary Case ReportA 22-year-old female patient, admitted at the Intensive Care Unit (ICU) of a tertiary hospital developed difficult-tocontrol diabetes insipidus after the excision of a frontal brain tumor (astrocytoma), together with septic conditions and mild hemodynamic alterations. On the 24 th postoperative day, the patient was going through the mechanical ventilation (MV) weaning process, with the following parameters: FiO 2 = 0.30; spontaneous breathing (30 rpm), PEEP = 5 cmH 2 O; apH = 7.50; PaO 2 = 62.2 mmHg; PaCO 2 = 27.6 mmHg; HCO 3 = 21.8 mmol/l; BE = -0.1 mmol/l; SatO 2 = 94.8%; PaO 2 /FiO 2 ratio= 207.The patient suddenly started to present respiratory difficulty, hypoxemia and hemodynamic worsening. With the diagnostic hypothesis of massive PE, a transthoracic echocardiogram was performed, which disclosed moderate dilation of the right chambers, moderate tricuspid regurgitation and pulmonary artery systolic pressure = 50 mmHg. The echocardiograma (ECG) showed the presence of S 1 Q 3 T 3 pattern.After this episode sthe MV was adjusted to: FiO 2 = 1; SIMV (12/38 rpm); PEEP = 8 cmH 2 O and TV = 500 ml; the subsequent arterial gasometry showed: pH = 7.26; PaO 2 = 44.5 mmHg; PaCO 2 = 54.6 mmHg; HCO 3 = 23.7 mmol/l; BE = -2.7 mmol/l; SatO 2 = 71.7%; PaO 2 /FiO 2 ratio = 44.5. Dobutamine was started, aiming at the hemodynamic function improvement. Three hours later, while still on mechanical ventilation, the patient presented the following parameters: FiO 2 = 1; SIMV (14/27 rpm); PEEP = 10 cmH 2 O; TV = 500 ml, arterial gasometry showed: pH = 7.22; PaO 2 = 50.7 mmHg; PaCO 2 = 54.7 mmHg; HCO 3 = 21.3 mmol/l; BE = -6.2 mmol/l; SatO 2 = 82.3%; PaO 2 /FiO 2 ratio= 50.7.Through the VC, the end-tidal CO 2 pressure (PetCO 2 ) was determined (CO 2 SMO PLUS 8100 Dixtal/Novametrix™) which, associated to the arterial gasometry (Radiometer ABL 700™), allowed the calculation of different derived indices, such as end-tidal alveolar dead space fraction ,(AVDSf), the late dead space fraction (fDlate), the CO 2 arterial-alveolar gradient [P(a-et) CO 2 ]; and the slope of phase III of the CO 2 spirogram (Slp III).Considering the patient's rapid deterioration, imminent risk of death and VC values indicative of increase in the alveolar dead space...

COPD phenotypes on computed tomography and its correlation with selected lung function variables in severe patients

“…It has the same shape of the other gas elimination curves, with the advantage of being obtained with a gas which is normally produced in the body and eliminated by the lungs. 11 , 12 The main variables analyzed were end-tidal concentration of carbon dioxide (ETCO 2 ), Slope of phase 2 (Slp2), and Slope of phase 3 (Slp3) of capnogram. Slp2 represents the rapid increase in CO 2 coming from short paths to alveoli; it comes immediately after the elimination of the air from the dead space.…”

Near-fatal pulmonary embolism: capnographic perspective

“… 5 , 6 The same principle applies to the significant drop in the normalization of SII/P E CO 2 , SIII/P E CO 2 , SIII/PetCO 2 , and SIII/V Te (p < 0.0001 for all). Negative SIII values seem to be associated with vascular damage, 2 , 5 whereas an excessive increase in these values may be associated with airway damage (such as that occurring in bronchiectasis, cystic fibrosis, and COPD). 7 , 8 …”

PetCO2, VCO2 and CorPP Values in the Successful Prediction of the Return of Spontaneous Circulation: An Experimental Study on Unassisted Induced Cardiopulmonary Arrest

“…Capnography presents itself as a non-invasive method, applicable at the bedside, that allows for the assessment of cardiorespiratory status both in experimental 2 - 6 ] and clinical studies [ 7 - 12 ] . In addition, it is considered an indicator and/or guide for decisions that enables the assessment of the quality of the CPR maneuvers [ 13 ] .…”