Pulmonary function stability monitored by electrical impedance tomography (EIT) with ideal PEEP chosen by rapid versus slow PEEP titration maneuver

Abstract

The acute respiratory distress syndrome (ARDS) increases the morbidity and mortality of patients admitted to the intensive care unit. In the postoperative period of cardiac surgery, the use of intraoperative cardiopulmonary bypass is one of the triggers of the syndrome, increasing its incidence. Potentially a protective ventilatory strategy with optimal PEEP setting individualized and identified quickly and safely, could improve the prognosis of these patients. Objectives: a) Compare the PEEP values needed and clinical effects of PEEP titrated by electrical impedance tomography (EIT), against the standard treatment of the institution (PEEP of 8-12 cm H2O), and B) in patients randomized to titrate the PEEP value, evaluate the concordance between the results of a rapid titration (total procedure duration = 5 min) versus slow titration already validated (total procedure duration = 40 min) of the same patient, sequentially. Methods: physiological study, a prospective, randomized, to be conducted in the surgical ICU of Incor-HCFMUSP. Attend patients after cardiac surgery with a diagnosis of ARDS will be randomized to receive the standard treatment of the institution or to receive optimal PEEP titration (via TIE) then protective ventilation adjusted for optimal PEEP titration identified by fast manuever. All patients will be followed for 4 hours and monitored by TIE, with measurements of the evolution of alveolar collapse. Hemodynamic and oxygenation will also be recorded. (AU)