Alveolar dead space and capnographic variables before and after thrombolysis in patients with acute pulmonary embolism.
Pulmonary embolism (PE) is a common condition. The central aim of this study was to describe the use of volumetric capnography (VCap) before and after fibrinolytic treatment of major PE. Lung scintigraphy was used as a base of comparison for the results of this treatment. We describe the cases of two conscious and spontaneously breathing patients (20- and by 24-year-old women) with major PE undergoing thrombolysis. Curves of CO(2) were obtained VCap and associated with arterial blood gas analysis and D-dimer. The pattern of VCap was compared with the VCap of health volunteers. Parameters also calculated were: P(a-et)CO(2) gradient, alveolar dead space fraction (AVDSf ), late dead space fraction (fDlate), and slope phase III (Slp III). The VCap results before and after thrombolysis for patients 1 and 2 were, respectively, P(a-et)CO(2): 12.6 to 5.8 and 7.9 to 1.6 (mmHg); AVDSf: 0.46 to 0.18 and 0.25 to 0.05; fDlate: 0.46 to 0.21 and 0.24 to 0.04; Slp III: 1.75 to 5.10 and 1.21 to 5.61 (mmHg/L). Lung scintigraphy was used to compare VCap results from the two subjects with VCap results from healthy volunteers and pigs before and after treatment associated with arterial blood gas, D-dimer, and showed satisfactory agreement.
Department of Surgery, State University of Campinas, School of Medical Sciences, Campinas, Brazil. marcosmm@fcm.unicamp.br
Marcos Mello
MM
Moreira
Renato G G
RG
Terzi
Carlos Heitor N
CH
Carvalho
Antonio Francisco
AF
de Oliveira Neto
Mônica Corso
MC
Pereira
Ilma Aparecida
IA
Paschoal
D000208:Acute Disease; D000818:Animals; D015415:Biomarkers / Q000097:blood; D019296:Capnography; D002245:Carbon Dioxide / Q000097:blood*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D008954:Models, Biological; D055420:Perfusion Imaging; D011652:Pulmonary Circulation / Q000187:drug effects*; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012126:Respiratory Dead Space / Q000187:drug effects*; D013552:Swine; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014692:Ventilation-Perfusion Ratio / Q000187:drug effects*; D055815:Young Adult
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002245:Carbon Dioxide