Download - Bronchoscopy in icu and anesthesia
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Carlos Darcy Alves Bersot TSA.SBA MD RESPONSÁVEL PELO CET H.F.LAGOA
Médico Anestesiologista do Hospital Federal da Lagoa-SUS Médico Anestesiologista do Hospital Universitário Pedro Ernesto-UERJ
Fibroscopia aplicada ao paciente critico e no manejo da via aérea difícil
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História da Broncoscopia
• Gustav Killian – 1898 – Alemanha >> Corpo estranho e sua repercussão na cirurgia torácica
!
• Chevalier Jackson – 1904 – EUA !
• Shigeto Ikeda – Japão - 1966 Broncofibroscópio
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Currently, rigid bronchoscopes are not often used except for the management of massive haemoptysis, removal of tracheobronchial foreign bodies, laser photoresection for obstructing endobronchial tumours, dilatation of tracheobronchial strictures and placement of airway stents.1,4
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TECNICAINTRODUÇÃO
Procedimento invasivo muito solicitado em UTI !
Segurança
Facilidade
Portabilidade
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Identificação correta do paciente
Estado de consciencia
Avaliar via aerea: Verificar o tamanho do TET(minimo 8.0nFr)
Consentimento Informado
Resultado laboratorial(Coagulação, Creatinina)
Acesso Vascular(periférico e central) permeável
Resumindo…
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18
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Outros dados históricos
Cateter de aspiração com um “olho” !Tratamento de atelectasias !Não foram reportados complicações do procedimento !Bem tolerados, inclusive por pacientes críticos !Uso importante em pacientes selecionados em ICU
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INDICAÇÕES• Inspeção direta das vias aéreas
• Estenoses, trauma, inflamação, sangramento
• Solução de atelectasias refrataria !
• Coletar material para cultura
• Biopsia transbronquial
• Guia para intubação em, pacientes com VAD(veremos a seguir)
• Guia para realização de TQT
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Aplicação em protocolos de investigação
Lavado bronquioalveolar
Dosar citocinas, celularidade, níveis de farmacos
Níveis inflamatorios
SARA
Patologias autoimunes
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Complicações potencialmente fatais
Relacionadas ao traumatismo e ou hipoxemia Sangramamento ativo Arritmia cardiaca que requer tratamento IAM-Edema Pulmonar Pneumotórax
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Contra indicações de FBC em UTI
• IAM nas ultimas 4-6 semanas previas • 5% de mortalidade.Pacientes com isquemia ativa no momento da FBC
• Trombocitopenia < 50.000/mm3 • Mortalidade de 5,4 % por sangramento maior • Sangramento menor em 32%
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Contra indicacoes relativas
PEEP> 15cm H2O !Hipertensão intracraniana !Arritmia e broncoespasmo presentes
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LEVAR EM CONSIDERAÇÃOSelecionar broncofibroscopia
5.7mm
Lubrificação
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• Diâmetro externo do aparelho: 3,4 mm até 6,3 mm (TOT 4,5 ! 8) !• Diâmetro do canal de trabalho: 1,2 até 3,2 mm !• Aparelho HUR: Olympus, micro-câmera acoplável, broncofibroscópio com 4,9 mm de diâmetro externo e canal
de trabalho de 2,2 mm (TOT 7,0)
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TRANSLARYNGEAL BLOCKTHIS IS MORE CORRECTLY DESCRIBED AS A METHOD OF TOPICALLY APPLYING LOCAL ANESTHETIC TO THE TRACHEA AND LARYNX. THE COVERAGE OF THIS METHOD IS SPOTTY AND IS MOST OFTEN INADEQUATE FOR FIBEROPTIC INTUBATION. THE METHOD REQUIRES ACCESS TO THE ANT. NECK AND SOME EXTENSION OF THE HEAD, SO THAT THE CRICOTHYROID MEMBRANE CAN BE IDENTIFIED.
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VVVVV
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Contra indicações
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`
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`
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VVV
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Bloqueadores de Mordida e Guias para Intubação
Cânula de OVASSAPIAN
Cânula de WILLIAMS
Cânula de BERMAN
Cânula VAMA (HUR)
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e se nada der certo…
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