Mechanisms of Action (MoA)
Patient walked into hospital comfortably.
During surgery, blood pressure dropped. (Picture is not the patient).
Aggressive fluid resuscitative initiative undertaken.
Answer to be posted tomorrow.
Patient stabilized intra-operatively.
Pre-operatively : 100% alveoli are patent.
Aggressive fluid resuscitative initiative is swishing around the blood vascular system and starting to weep into the lun … specifically into the pulmonary interstium… and will eventually crush alveoli into an atelectatic state.
Alveoli progressively becoming atelectatic.
“Vt vs. time scalar” is trending upward …indicative that the lung is slowly regaining atelectatic alveoli … demonstrating that the applied PEEP and mean airway pressure is therapeutically efficacious.
“Vt vs. time scalar” is trending upward …indicative that the lung is EXONENTIALLY regaining atelectatic alveoli … demonstrating that the applied PEEP and mean airway pressure is therapeutically efficacious.
Pre-operative lung in great physiologic state.
Intra-operative aggressive fluid resuscitative initiative. Pulmonary capillaries now full of 20L of fluid …represented now as dark yellow.
Now, the 20L of fluid is seeping into the pulmonary interstium and the pulmonary interstitial is also demonstrated as dark yellow.
The pulmonary capillary pressure rose from capillary pressure=CVP=2 to 20.
The pulmonary interstitial tissue pressure rose from 0 to 20 cmH2O.
The alveoli with a PEEP=14 cmH2O is trying to avoid the crushing pulmonary interstial pressure=20.
Some alveoli are losing the fight of PEEP =14 vs. pulmonary interstitial and becoming atelectatc …seen in dark blue as an atelectatic alveolus.
The alveoli lack the PEEP or lack therapeutic mean airway pressure to negate whatever crushing forces are impinging the external alveolus.
It is very important to monitor and rectify progressive atelectasis.