ALINE MAGALHAES AMBROSIO

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VCI, FMVZ - Docente
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 18 Citação(ões) na Scopus
    Ventilation distribution assessed with electrical impedance tomography and the influence of tidal volume, recruitment and positive end-expiratory pressure in isoflurane-anesthetized dogs
    (2017) AMBROSIO, Aline M.; CARVALHO-KAMAKURA, Tatiana P. A.; IDA, Keila K.; VARELA, Barbara; ANDRADE, Felipe S. R. M.; FACO, Lara L.; FANTONI, Denise T.
    Objective To examine the intrapulmonary gas distribution of low and high tidal volumes (V-T) and to investigate whether this is altered by an alveolar recruitment maneuver (ARM) and 5 cmH(2)O positive end-expiratory pressure (PEEP) during anesthesia. Study design Prospective randomized clinical study. Animals Fourteen client-owned bitches weighing 26 +/- 7 kg undergoing elective ovariohysterectomy. Methods Isoflurane-anesthetized dogs in dorsal recumbency were ventilated with 0 cmH(2)O PEEP and pressure-controlled ventilation by adjusting the peak inspiratory pressure (PIP) to achieve a low (7 mL kg(-1); n = 7) or a high (12 mL kg(-1); n = 7) V-T. Ninety minutes after induction (T90), an ARM (PIP 20 cmH(2)O for 10 seconds, twice with a 10 second interval) was performed followed by the application of 5 cmH(2)O PEEP for 35 minutes (RM35). The vertical (ventral = 0%; dorsal = 100%) and horizontal (right = 0%; left = 100%) center of ventilation (CoV), four regions of interest (ROI) (ventral, central-ventral, central-dorsal, dorsal) identified in electrical impedance tomography images, and cardiopulmonary data were analyzed using two-way repeated measures ANOVA. Results The low V-T was centered in more ventral (nondependent) areas compared with high V-T at T90 (CoV: 38.8 +/- 2.5% versus 44.6 +/- 7.2%; p = 0.0325). The ARM and PEEP shifted the CoV towards dorsal (dependent) areas only during high V-T (50.5 +/- 7.9% versus 41.1 +/- 2.8% during low V-T, p = 0.0108), which was more distributed to the central-dorsal ROI compared with low V-T (p = 0.0046). The horizontal CoV was centrally distributed and cardiovascular variables remained unchanged throughout regardless of the V-T, ARM, and PEEP. Conclusions and clinical relevance Both low and high V-T were poorly distributed to dorsal dependent regions, where ventilation was improved following the current ARM and PEEP only during high V-T. Studies on the role of high V-T on pulmonary complications are required.
  • article 17 Citação(ões) na Scopus
    A comparison of the cardiopulmonary effects of pressure controlled ventilation and volume controlled ventilation in healthy anesthetized dogs
    (2016) FANTONI, Denise T.; IDA, Keila K.; LOPES, Thomas F. T.; OTSUKI, Denise A.; AULER JR., Jose Otavio C.; AMBROSIO, Aline M.
    Objective - To compare the effects of pressure controlled ventilation (PCV) with volume-controlled ventilation (VCV) on lung compliance, gas exchange, and hemodynamics in isoflurane-anesthetized dogs. Design - Prospective randomized study. Setting - Veterinary teaching hospital. Animals - Forty client-owned bitches undergoing elective ovariohysterectomy. Interventions - Dogs were randomly assigned to be ventilated with 100% oxygen using PCV (n = 20) or VCV (n = 20). The respiratory rate was 20/min and positive end-expiratory pressure (PEEP) was 5 cm H2O, with a tidal volume of 10 mL/kg. Cardiac output (CO) was measured using thermodilution. Cardiopulmonary and blood gas data were obtained during spontaneous ventilation and after 30 (T30) and 60 minutes (T60) of controlled ventilation. Measurements and Main Results - In dogs ventilated with PCV, at T30 and T60, PIP was lower (11.4 +/- 1.9 and 11.1 +/- 1.5 cm H2O, respectively) and static compliance (C-ST) was higher (51 +/- 7 and 56 +/- 6 mL/cm H2O, respectively) than in VCV group (PIP of 14.3 +/- 1.3 and 15.5 +/- 1.4 cm H2O; C-ST of 34 +/- 8 and 33 +/- 9 mL/cm H2O, P < 0.0001). Compared with spontaneous ventilation, both groups had decreased alveolar-arterial oxygen difference at T30 and T60 (PCV: 128 +/- 32 mm Hg vs 108 +/- 20 and 104 +/- 16 mm Hg, respectively; VCV: 131 +/- 38 mm Hg vs 109 +/- 19 and 107 +/- 14 mm Hg, respectively; P < 0.01), while CO was maintained at all time points. Conclusions - Compared to spontaneous ventilation, both ventilatory modes effectively improved gas exchange without hemodynamic impairment. PCV resulted in higher lung C-ST and lower PIP compared to VCV.