A importância da pressão pleural na avaliação da mecânica respiratória

Fernandes, Cláudia Regina

doi:10.1590/s0034-70942006000300009

Cited by 9 publications

(9 citation statements)

References 58 publications

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“…It is assumed that after sedation, the patient will be fully dependant on mechanical ventilation and not have spontaneous breathing effort. This assumption thus assumes the patient's pleural pressure ( P pl ) after sedation is zero and allows P pl in Equation (3) to be omitted, which may not be entirely valid [32]. However, this assumption is made for the first step study to prove the concept within a simpler situation.…”

Section: Discussionmentioning

confidence: 99%

Model-based PEEP optimisation in mechanical ventilation

et al. 2011

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BackgroundAcute Respiratory Distress Syndrome (ARDS) patients require mechanical ventilation (MV) for breathing support. Patient-specific PEEP is encouraged for treating different patients but there is no well established method in optimal PEEP selection.MethodsA study of 10 patients diagnosed with ALI/ARDS whom underwent recruitment manoeuvre is carried out. Airway pressure and flow data are used to identify patient-specific constant lung elastance (Elung) and time-variant dynamic lung elastance (Edrs) at each PEEP level (increments of 5cmH2O), for a single compartment linear lung model using integral-based methods. Optimal PEEP is estimated using Elung versus PEEP, Edrs-Pressure curve and Edrs Area at minimum elastance (maximum compliance) and the inflection of the curves (diminishing return). Results are compared to clinically selected PEEP values. The trials and use of the data were approved by the New Zealand South Island Regional Ethics Committee.ResultsMedian absolute percentage fitting error to the data when estimating time-variant Edrs is 0.9% (IQR = 0.5-2.4) and 5.6% [IQR: 1.8-11.3] when estimating constant Elung. Both Elung and Edrs decrease with PEEP to a minimum, before rising, and indicating potential over-inflation. Median Edrs over all patients across all PEEP values was 32.2 cmH2O/l [IQR: 26.1-46.6], reflecting the heterogeneity of ALI/ARDS patients, and their response to PEEP, that complicates standard approaches to PEEP selection. All Edrs-Pressure curves have a clear inflection point before minimum Edrs, making PEEP selection straightforward. Model-based selected PEEP using the proposed metrics were higher than clinically selected values in 7/10 cases.ConclusionContinuous monitoring of the patient-specific Elung and Edrs and minimally invasive PEEP titration provide a unique, patient-specific and physiologically relevant metric to optimize PEEP selection with minimal disruption of MV therapy.

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Section: Discussionmentioning

confidence: 99%

Model-based PEEP optimisation in mechanical ventilation

et al. 2011

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“…The intra-esophageal pressure is lower than the intra-gastric; the LES is characterized by being a zone of 2 to 4 cm of extension with higher pressure than the stomach and is therefore an effective barrier against the gastro-esophageal reflux (Fernandes, 2006). In this region, we sought to represent the entire process of muscle and pressure waves and pleural interference by a torsional spring and a linear spring.…”

Section: Regions E and Fmentioning

confidence: 99%

Bond Graph modeling of the human esophagus and analysis considering the interference in the fullness of an individual by reducing mechanical esophageal flow

Rosa¹,

Altoé²

2013

RBEB

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Este artigo está licenciado sob uma licença Creative Commons Atribuição-NãoComercial 4.0 Internacional. Você tem direito de:Compartilhar -copiar e redistribuir o material em qualquer suporte ou formato.Adaptar -remixar, transformar, e criar a partir do material. De acordo com os termos seguintes:Atribuição -Você deve dar o crédito apropriado, prover um link para a licença e indicar se mudanças foram feitas. Você deve fazê-lo em qualquer circunstância razoável, mas de maneira alguma que sugira ao licenciante a apoiar você ou o seu uso Não Comercial -Você não pode usar o material para fins comerciais.Sem restrições adicionais -Você não pode aplicar termos jurídicos ou medidas de caráter tecnológico que restrinjam legalmente outros de fazerem algo que a licença permita.This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. You are free to:Share -copy and redistribute the material in any medium or format.Adapt -remix, transform, and build upon the material. Under the following terms:Attribution -You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.NonCommercial -You may not use the material for commercial purposes.No additional restrictions -You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. Artigo Original

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“…2006). The use of an intraluminal oesophageal catheter with a balloon manometer is commonly employed for purposes of estimating P pl in order to preclude the (invasive) placement of an intrapleural canula (Fernandes 2006; Behazin et al . 2010).…”

Section: Introductionmentioning

confidence: 99%

“…The use of oesophageal manometry has been well documented for evaluation of both static and dynamic P pl in human and veterinary medicine (Lanteri et al . 1994; Fernandes 2006).…”

Section: Introductionmentioning

confidence: 99%

“…In order to evaluate the mechanics of breathing, it is necessary to measure both pleural pressure (Ppl) and IAP (Silva et al 2006). The use of an intraluminal oesophageal catheter with a balloon manometer is commonly employed for purposes of estimating Ppl in order to preclude the (invasive) placement of an intrapleural canula (Fernandes 2006;Behazin et al 2010). The use of oesophageal manometry has been well documented for evaluation of both static and dynamic Ppl in human and veterinary medicine (Lanteri et al 1994;Fernandes 2006).…”

Section: Introductionmentioning

confidence: 99%

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