Dados do Trabalho

Título

Automatic lateral therapy in the management of unilateral pulmonary pneumonia with cavitations post-mechanical ventilation accidental disconnection: a case study monitored by electrical impedance tomography.

Descrição do caso

Electrical impedance tomography (EIT) has proven useful for monitoring lung recruitment strategies in critically ill patients. This study reports the case of a 77-year-old male patient, under 24 hours of mechanical ventilation (MV) in a protective strategy, with septic shock of pulmonary origin and chronic obstructive pulmonary disease. Chest tomography revealed consolidations with cavitations at the left base, indicating necrotizing pneumonia and lung abscess. The EIT revealed heterogeneity in the distribution of ventilation (∆Z): Upper Left 20.61%, Upper Right 18.85%, Lower Left 6.79%, and Lower Right 53.73%, with left unilateral posterior involvement. Due to an accidental disconnection of the MV, the EIT detected a significant collapse of the entire left hemithorax (∆Z 13%). Given the presence of pulmonary cavitations, which contraindicate recruitment techniques involving increased pressure, the decision was to implement automatic lateral therapy (ALT®) monitored by EIT for 2.5 hours. The protocol included lateral rotations to 15° and 30° and supine positioning, with each position maintained for 30 minutes. During therapy, the patient remained stable with no adverse events, and there was an improvement in left lung ventilation to 31.17%, with the best response at 15° of lateralization (∆Z reaching 35.72%). Lung compliance increased from 56 to 62 ml/cmH2O, and resistance decreased from 29 to 14 cmH2O/L/s. It is concluded that the lateral rotation therapy promoted favorable effects on ventilation distribution and respiratory mechanics without the need for potentially risky strategies in patients with irreversible unilateral lung impairments. Study financed by CAPES001, FACEPE (APQ-0249-4.0, IBPG-1976-4.08/22, IBPG-0398-2.12/23), CNPq-403341/2020-5; APQ 306240/2021-1.