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Trombólise na embolia pulmonar maciça com base na capnografia volumétrica

Marcos Mello Moreira, Renato Giuseppe Giovanni Terzi, Ilma Aparecida Paschoal, Luiz Cláudio Martins, Evandro Pinto da Luz Oliveira, Antonio Luis Eiras Falcão
2010 Arquivos Brasileiros de Cardiologia  
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
more » ... ormal < 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. A 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. Volumetric capnography in massive PE Arq Bras Cardiol 2010; 95(4): e97-e100
doi:10.1590/s0066-782x2010001400025 pmid:21180783 fatcat:rfl7mdzu6ndkxcesacbjuhhpcy