Energy usage in buildings has become a major topic of research in the past decade, driven by the increased cost of energy. Designing buildings to use less energy has become more important, and the ability to analyze buildings before construction can save money in design changes. Computational fluid dynamics (CFD) has been explored as a means of analyzing energy usage and thermal comfort in buildings. Existing research has been focused on simple buildings without much application to real buildings. The current study attempts to expand the research to entire buildings by modeling two existing buildings designed for energy efficient heating and cooling. The first is the Viipuri Municipal Library (Russia) and the second is the Margaret Esherick House (PA). The commercial code FLUENT is used to perform simulations to study the effect of varying atmospheric conditions and configurations of openings. Three heating simulations for the library showed only small difference in results with atmospheric condition or configuration changes. A colder atmospheric temperature led to colder temperatures in parts of the building. Moving the inlet only slightly changed the temperatures in parts of the building. The cooling simulations for the library had more drastic changes in the openings. All three cases showed the building cooled quickly, but the velocity in the building was above recommended ranges given by ASHRAE Standard 55. Two cooling simulations on the Esherick house differed only by the addition of a solar heat load. The case with the solar heat load showed slightly higher temperatures and less mixing within the house. The final simulation modeled a fire in two fireplaces in the house and showed stratified air with large temperature gradients. / Master of Science

This thesis examines potential improvements to current coal mine fire response measures. In the event of a fire scenario, indirect testing and analysis of the exhausting air is needed to characterize changes in the fire. The application of multiple passive source tracers provides improved detail of complex ventilation interactions over an extended period of time. The first work in this thesis details the testing of the passive release rates for three Perfluorocarbon tracer compounds over a 180-day period. The results of this study demonstrate the ability for the permeation plug release vessel design to release Perfluorocarbon tracers at a steady rate. Current response methods for a fire in a coal mine gob consist of injection of inert gas and sealing of the mine openings. Injection of high expansion foam into the gob from the surface has potential to improve extinguishment of the fire and reduce the time needed to bring the mine back to an operational state. The applicability of this method requires computational modeling and field testing. The second part of this thesis determines the Darcy and Forchheimer values for high expansion foam flow in simulated gob material with a lab experiment. The experiment was replicated in the CFD software, OpenFOAM, to validate the methods for calculation of the Darcy and Forchheimer values. The results of this study provide a tested methodology for a future full scale modeling of high expansion foam injection in a coal mine gob. / Master of Science / This thesis examines potential improvements to current coal mine fire response measures. In the event of a mine fire, indirect testing of mine air exhaust is needed to track changes in the fire. The use of multiple passive tracer gas testing allows for better detail of air movement over a longer period of time. The first work in this thesis details the testing of the gas release rates for three Perfluorocarbon tracer gases over a 180-day timeframe. The results of this study show the ability for the gas release design to release Perfluorocarbon tracers at a steady rate needed for mine air exhaust testing. Current methods to extinguish a fire in a coal mine gob involve adding inert gas to the mine and sealing the mine openings. Pumping of high expansion foam into the caved area of the coal mine from the surface has potential to improve extinguishment of the fire and reduce the time needed to bring the mine back to normal conditions. The potential of this method is determined by computer simulations and lab testing. The second part of this thesis determines the characteristics for foam flow in simulated caved material. The lab test was replicated in a computer simulation to prove the methods used to characterize the foam flow were accurate. The results of this study provide a proven method for future full scale computer simulations of foam flow in the caved area of a coal mine.

A fairly large portion of patients receiving surgical or intensive care will need mechanical ventilation at some point. The potential ventilator-induced lung injury (VILI) is thus of interest. One of the main causal factors in VILI is the cyclic energy shifts, i.e. tidal volumes, in the lung during mechanical ventilation. The problem can be approached in two ways. Firstly, one can utilize apneic oxygenation and thus not cause any tidal injuries at all. Secondly, and more traditionally, one can simply lower the tidal volumes and respiratory rates used. The following describes a series of animal experiments exploring these options. In the first two papers, I explored and improved upon the methodology of apneic oxygenation. There is a generally held belief that it is only possible to perform apneic oxygenation by prior denitrogenation and by using 100% oxygen during the apnea. As 100% oxygen is toxic, this has prevented apneic oxygenation from more widespread use. The first paper proves that it is indeed possible to perform apneic oxygenation with less than 100% oxygen. I also calculated the alveolar nitrogen concentration which would conversely give the alveolar oxygen concentration. The second paper addresses the second large limitation of apneic oxygenation, i.e. hypercapnia. Using a high dose infusion of tris(hydroxymethyl)aminomethane (THAM) buffer, a pH > 7.2 could be maintained during apneic oxygenation for more than 4.5 hours. In the last two papers, THAM’s properties as a proton acceptor are explored during respiratory acidosis caused by very low volume ventilation. In paper III, I found that THAM does not, in the long term, affect pH in respiratory acidosis after stopping the THAM infusion. It does, however, lower PVR, even though the PaCO2 of THAM-treated animals had rebounded to levels higher than that of the controls. In the last experiment, I used volumetric capnography to confirm our hypothesis that carbon dioxide elimination through the lungs was lower during the THAM infusion. Again, the PaCO2 rebounded after the THAM infusion had stopped and I concluded that renal elimination of protonated THAM was not sufficient.

This rapport contains an examination of the energy consumption of a kindergarten, which areas that have the largest impact on the energy consumption and what can be done to reduce those areas in ways that are relatively easy and profitable. It is also analyzed if it is possible to reduce the energy consumption from today’s consumption to a consumption that fulfils the demands placed on low energy houses by FEBY. The focus has been on reducing the energy consumption of the areas ventilation, heating system and hot water system, since those seemed to be the easiest ones to affect and since the building is quite recently built. There are different kinds of ventilation systems, at the moment the building have a CAV-system, which means that the ventilation is too high during large parts of the day. There are different ways to manage the ventilation system, for example presence detection, humidity sensors, CO2 sensors, temperature sensors and season adjustment. Many of those are in the end dependent on CO2 sensors to guarantee a good indoor climate, therefore the focus have been placed on this system.   The building is heated through district heating which is relatively easy to connect to a couple of sun panels to contribute to the heating system and hot water system. There are different ways of connecting district heating with solar panels and those are described, as well as the cost and the repayment time. A comparison with a building with an electric heating system has been made as well. It is important to get solutions that are profitable, that the repayment time isn’t too long. Solar cells and wind turbines are examined as well, but the repayment time for solar cells are too long at the moment. The repayment time for solar cells varies between 42 - 75 years, while the expected lifetime is 25 years. Concerning ventilation, a reduced ventilation of 10, 20, 30, 40 and 50 % have been examined. With only reduced ventilation the demands on low energy houses could not be matched, but it was possible in two cases with the use of solar panels. The usage of a wind turbine meant that the ventilation had to be reduced even less to match the demands on low energy houses. The repayment times for the solar panels and the wind turbine are both around 14 years. / Rapporten behandlar en undersökning av energiförbrukningen vid en projekterad förskola och vilka poster som har störst inverkan på energiförbrukningen, samt vad som kan göras för att åtgärda dessa på ett sätt som är relativt enkelt och som är lönsamt. Det ses över om det är möjligt att få ner energiförbrukningen från dagens förbrukning som uppfyller BBR:s krav, till att uppfylla de lägre energikraven som gäller för minienergihus enligt FEBY. Med utgångspunkt i energiförbrukningsberäkningen som gjorts och det faktum att förskolan är relativt nybyggd så har fokus lagts på att minska ner posterna ventilation, värmesystemet och varmvattnet då dessa är de poster som är lättast att påverka. När det gäller ventilation finns olika styrsätt, byggnaden har i nuläget ett CAV-system, vilket innebär att ventilation under stora delen av dagen är för hög. Det finns olika saker att styra ventilationen och minska ner den på, däribland närvarogivare, fuktgivare, koldioxidgivare, temperaturgivare samt årstidsanpassning. Många av dessa är dock i slutändan beroende av koldioxidgivare för att garantera inomhusklimatet, så därför har fokus lagts på detta system. Byggnaden värms upp via fjärrvärme och det är relativt enkelt att koppla på solfångare för hjälp av uppvärmning av värmesystemet och varmvattnet. Det finns olika sätt att koppla in solfångare på system med fjärrvärme och de olika sätten beskrivs och undersöks, liksom kostnad och återbetalningstid för en anläggning med solfångare. En jämförelse med en byggnad med eluppvärmning har också gjorts. Det är viktigt att få ekonomisk lönsamhet i det hela och således att återbetalningstiden inte ska vara för lång. Även solceller och vindkraftverk tas upp, dock är återbetalningstiden för solceller i nuläget alltför lång för att vara ekonomiskt försvarbart. Återbetalningstiden för solceller varierar mellan 42 – 75 år, medan den beräknade livslängden ligger på 25 år. När det gäller ventilationen så har minskad ventilation med 10, 20, 30, 40 och 50 % undersökts. Med enbart minskad ventilation kan inte kravet för lågenergihus uppfyllas, men inräknat solfångare så nåddes i två fall lågenergihus. Till sist så innebar medräknandet av ett vindkraftverk att ventilationen inte behövdes minskas lika mycket för att uppfylla kraven för lågenergihus. Återbetalningstiden för solfångarna beräknades till 14 år och återbetalningstiden för vindkraftverket till 14 år.

Bakgrund: Vid generell anestesi utvecklar patienten oftast atelektaser, vilket ökar risken för försämrat syreutbyte och kan ge upphov till respiratoriska komplikationer. En åtgärd för att minska förekomsten av dessa atelektaser är utförandet av vitalkapacitetsmanöver (VKM). Även om VKM är en vedertagen manöver så finns det inga nationella riktlinjer kring användandet av VKM. Detta gör att den kliniska användningen av VKM varierar stort och oftast beror på vårdpersonalens attityder och preferenser. Syfte: Undersöka anestesisjuksköterskors erfarenheter kring beslutsfattanden och utförande av vitalkapacitetsmanöver på vuxna patienter under generell anestesi. Metod: Studien genomfördes som en intervjustudie med kvalitativ design och induktiv ansats. Resultat: Analysen resulterade i totalt fem huvudkategorier; Anestesisjuksköterskans ansvar i beslutsfattandet av att utföra VKM, Att känna sig trygg med arbetsuppgiften, Vad som ligger till grund för anestesisjuksköterskans beslut, Betydelsen av erfarenhet, kompetens och kunskap samt Att jobba efter riktlinjer och direktiv. Slutsats: Anestesisjuksköterskor upplever oklarheter kring utförandet av VKM när det gäller ansvarsfördelning, vem som får utföra åtgärden och på vilket sätt VKM bör utföras. Det finns även en brist på både nationella och regionala riktlinjer och rutiner kring användandet av VKM. Förtydligande kring de oklarheter som finns, implementering av tydliga rutiner på arbetsplatsen samt utformning av riktlinjer kan skapa en större trygghet och användning av VKM bland anestesisjuksköterskor. Detta leder i sin tur till bättre vård och minskat lidande för patienten. / Background: In general anesthesia patients often develop atelectasis, which increases the risk of deteriorated gas exchange and respiratory complications. A preventive measure to decrease these atelectasis is to perform a vital capacity maneuver (VCM). Even if VCM is an established maneuver there is no guidelines about the usage of VCM. This results in a varied use of VCM and it often depends on hospital staff’s attitudes and preferences. Aim: To examine the experience of anesthesia nurses regarding decision-making and performance of vital capacity maneuvers in adult patients under general anesthesia. Method: The study was implemented as an interview studie with qualitative design and an inductive reasoning. Result: The analysis resulted in a total of five main categories; The anesthesia nurse's responsibility in the decision-making of performing VCM, To feel safe with the task, What is the basis for the anesthesia nurse's decision, The importance of experience, competence and knowledge and To work according to guidelines and directives. Conclusion: Anesthesia nurses experience ambiguities regarding the performance of VCM in terms of division of responsibilities, who may perform the measure and in what way VCM should be performed. There is also a lack of both national and regional guidelines and routines regarding the use of VCM. Clarification of the ambiguities that exist, implementation of clear routines in the workplace and design of guidelines can create greater security and promote the use of VCM among anesthesia nurses. This in turn leads to better care and reduced suffering for the patient.

La performance d’un système doit être bien définie, atteignable et surtout mesurable. Ce n’est pas le cas aujourd’hui pour la ventilation. D’une part, les performances des systèmes de ventilation sont habituellement exprimées sur des considérations énergétiques ou tout simplement sur une estimation trop approximative des débits de ventilation. Les performances liées au confort thermique et à la qualité de l’air intérieur sont abordées séparément à travers des outils d’évaluation dédiés. D’autre part, les outils d’évaluation existants sont aujourd’hui limités dans leur mise en pratique pour des mesures in situ, notamment lorsqu’il s’agit de ventilation naturelle et mixte. L’objectif de cette thèse est alors d’examiner et d’expérimenter les techniques expérimentales existantes à échelle réelle afin de proposer des améliorations sur les méthodes d’évaluation et de commissionnement. La thèse aborde la performance de la ventilation en prenant en compte l’efficacité de ventilation comme performance intrinsèque et le confort thermique comme performance globale.La première partie est consacrée à l’évaluation in situ des performances intrinsèques de ventilation (taux de ventilation, âges moyens de l’air et efficacité de renouvellement d’air), en se basant sur des techniques de gaz traceurs. Après une analyse théorique des différents indicateurs de performance de ventilation et de leurs techniques de mesure correspondantes, une étude expérimentale a été menée dans une salle de cours sous différentes stratégies de ventilation (mécanique, naturelle et mixte). Les analyses ont démontré l’importance de la mise en application des techniques de décroissance de gaz traceurs sur l’incertitude des taux de renouvellement d’air avec notamment une forte influence des temps de mesure et des concentrations de gaz utilisées. Une méthodologie a été adaptée puis testée pour la mesure de l’efficacité de renouvellement d’air en ventilation mécanique, naturelle et mixte en s’affranchissant de mesures en bouches d’extraction (technique habituellement utilisée et préconisée par les normes).La deuxième partie est consacrée à l’évaluation expérimentale in situ du confort thermique sous différentes configurations de ventilation. Différentes méthodes, standards et techniques d’évaluation ont été testés et comparés avec la perception des occupants. Les résultats ont démontré la présence de plusieurs inadéquations lors de la mise en pratique des méthodes et normes existantes. Principalement, il s’agit de l’inadéquation des méthodes statiques (PMV PPD) pour l’évaluation du confort en présence de conditions thermiques fluctuantes, y compris en ventilation mécanique. Les analyses d’incertitudes liées aux erreurs de mesure ont démontré l’incohérence des normes actuelles dans la classification des catégories de confort. / The performance of a system must be well defined, attainable and above all measurable. This is not the case today for ventilation. On the one hand ventilation performance is usually declined on energy efficiency considerations or simply on a rough estimation of ventilation rates. The performance related to thermal comfort and IAQ are addressed separately through dedicated evaluation tools. On the other hand, the existing evaluation tools today are nowadays limited in their practical applications for in situ measurements, in particular in the case of natural and mixed ventilation. The aim of the present thesis is to examine the existing experimental technics, at full scale building in order to propose improvements on evaluation methods and commissioning protocols. The present thesis deals with ventilation performance taking into account ventilation efficiency as intrinsic performance and thermal comfort as overall performance.The first part is devoted to the in situ assessment of intrinsic ventilation performance (ventilation rates, mean age of air, and air exchange efficiency), based on decay tracer gas techniques. After a theorical analysis of the various performance indexes and their corresponding measurement techniques, an experimental study was carried out in a classroom under different ventilation strategies (mechanical, natural & mixed mode). The analysis proved the importance of the application of the tracer gas decay on ventilation rates accuracy with in particular a strong influence of measurement times and used tracer gas concentration. A methodology has been adapted and tested for the measurement of the air exchange efficiency in natural and mixed mode ventilation, by avoiding measurements in exhaust vents (a technique usually used and advocated by current standards).The second part is devoted to in situ assessment of thermal comfort under different ventilation strategies. Different methods, standards and evaluation techniques were tested and compared with occupants’ perception. The results demonstrated the presence of several inadequacies during the implementation of existing methods and standards. Mainly, it concerns the inadequacy of static methods (PMV PPD) for thermal comfort assessment in the presence of fluctuating thermal conditions, even with mechanical ventilation. Uncertainty analysis related to measurement errors has demonstrated the incoherence of current standards in the classification of comfort categories.

En ventilation assistée, les interactions patient-ventilateur, qui sont associés au pronostic, dépendent pour partie des algorithmes de ventilation. Objectifs : Caractériser l'intérêt potentiel des nouveaux algorithmes de ventilation dans l'optimisation des interactions patient-ventilateur : 1) en ventilation invasive, deux modes et leurs algorithmes nous ont semblé novateurs et nous avons cherché à personnaliser l'assistance du ventilateur en fonction de l'effort respiratoire du patient au cours de ces modes proportionnels : ventilation assistée proportionnelle (PAV+) et ventilation assistée neurale (NAVA) ; 2) en ventilation non-invasive (VNI) nous avons évalué si les algorithmes VNI des ventilateurs de réanimation et des ventilateurs dédiés à la VNI diminuaient l'incidence des asynchronies patient-ventilateur. Méthodes : 1) En PAV+ nous avons décrit un moyen de recalculer le pic de pression musculaire réalisée par le patient à chaque inspiration à partir du gain réglé et de la pression des voies aériennes monitorée par le respirateur. Nous avons alors évalué la faisabilité clinique d'ajuster l'assistance en ciblant un intervalle jugé normal de pression musculaire. 2) Nous avons comparé une titration de l'assistance en NAVA et en aide inspiratoire (AI) en se basant sur les indices d'effort respiratoire. 3 et 4) En VNI, nous avons évalué l'incidence des asynchronies patient-ventilateur avec et sans l'utilisation d'algorithmes VNI : sur banc d'essai au cours de conditions expérimentales reproduisant la présence de fuites autour de l'interface ; en clinique chez des patients de réanimation. Résultats : En PAV+, ajuster le gain dans le but de cibler un effort respiratoire normal était faisable, simple et souvent suffisant pour ventiler les patients depuis le sevrage de la ventilation mécanique jusqu'à l'extubation. En NAVA, l'analyse des indices d'effort respiratoire a permis de préciser les bornes d'utilisation et de comparer les interactions patient-ventilateur avec l'AI dans des intervalles d'assistance semblables. En VNI, nos données pointaient l'hétérogénéité des algorithmes VNI sur les ventilateurs de réanimation et retrouvaient une meilleure synchronisation patient-ventilateur avec l'utilisation de ventilateurs dédiés à la VNI pour des qualités de pressurisation par ailleurs identiques. Conclusions : En ventilation invasive, personnaliser l'assistance des modes proportionnels optimise les interactions patient-ventilateur et il est possible de cibler une zone d'effort respiratoire normale en PAV+. En VNI, les ventilateurs dédiés améliorent la synchronisation patient-ventilateur plus encore que les algorithmes VNI sur les ventilateurs de réanimation, dont l'efficacité varie grandement selon le ventilateur considéré. / During assisted mechanical ventilation, patient-ventilator interactions, which are associated with outcome, partly depend on ventilation algorithms.Objectives: : 1) during invasive mechanical ventilation, two modes offered real innovations and we wanted to assess whether the assistance could be customized depending on the patient's respiratory effort during proportional ventilatory modes: proportional assist ventilation with load-adjustable gain factors (PAV+) and neurally adjusted ventilator assist (NAVA); 2) during noninvasive ventilation (NIV): to assess whether NIV algorithms implemented on ICU and dedicated NIV ventilators decrease the incidence of patient-ventilator asynchrony.Methods: 1) In PAV+ we described a way to calculate the muscle pressure value from the values of both the gain adjusted by the clinician and the airway pressure. We then assessed the clinical feasibility of adjusting the gain with the goal of maintaining the muscle pressure within a normal range. 2) We compared titration of assistance between neurally adjusted ventilator assist (NAVA) and pressure support ventilation (PSV) based on respiratory effort indices. During NIV, we assessed the incidence of patient-ventilator asynchrony with and without the use of NIV algorithms: 1) using a bench model; 2) and in the clinical settings.Results: During PAV+, adjusting the gain with the goal of targeting a normal range of respiratory effort was feasible, simple, and most often sufficient to ventilate patients from the onset of partial ventilatory support until extubation. During NAVA, the analysis of respiratory effort indices allowed us to precise the boundaries within which the NAVA level should be adjusted and to compare patient-ventilator interactions with PSV within similar ranges of assistance. During NIV, our data stressed the heterogeneity of NIV algorithms implemented on ICU ventilators. We therefore reported that dedicated NIV ventilators allowed better patient-ventilator synchronization than ICU ventilators, even with their NIV algorithms engaged.Conclusions: During invasive mechanical ventilation, customizing the assistance during proportional ventilatory modes with the goal of targeting a normal range of respiratory effort optimizes patient-ventilator interactions and is feasible with PAV+. During NIV, dedicated NIV ventilators allow better patient-ventilator synchrony than ICU ventilators, even with their NIV algorithm engaged. ICU ventilators' NIV algorithms efficiency is however highly variable among ventilators.

Des asynchronies patient-ventilateur sont fréquemment observées en ventilation assistée. Objectif : Déterminer l'incidence et les facteurs favorisants des asynchronies, venant du patient, du ventilateur ou des réglages, et préciser le réglage optimal du ventilateur. Méthodes : Nous avons évalué l'incidence des asynchronies avec une méthode simple et non invasive basée sur l'analyse des courbes du ventilateur. Chez les patients qui présentaient des efforts inefficaces, nous avons mesuré l'effort inspiratoire avec une sonde œsophagienne afin d'optimiser le réglage du ventilateur. Nous avons évalué l'impact du mode ventilatoire sur la qualité du sommeil avec une polysomnographie complète. Enfin, tous les ventilateurs de réanimation ont été testés sur banc afin de comparer les performances en termes de trigger et pressurisation. Résultats : Près d'un quart des patients présentaient des asynchronies fréquentes. La durée de ventilation de ces patients était plus longue et le sevrage plus difficile. Les efforts inefficaces, qui représentaient les asynchronies les plus fréquentes, étaient favorisés par une assistance ventilatoire excessive. La réduction du niveau d'aide inspiratoire (AI) permettait d'éliminer quasi-complètement les efforts inefficaces, sans augmenter l'effort inspiratoire et sans modifier la vraie fréquence respiratoire du patient. Le mode ventilatoire n'avait pas d'influence sur la qualité du sommeil et les asynchronies. Les efforts inefficaces survenaient aussi bien en AI qu'en ventilation assistée contrôlée. Avec un niveau d'AI adéquat, les apnées centrales étaient peu nombreuses et n'avaient pas d'influence sur la qualité du sommeil. Les performances insuffisantes observées avec certains ventilateurs peuvent également altérer la synchronisation. Conclusion : Les asynchronies patient-ventilateur sont fréquentes et associées à une durée de ventilation prolongée. Une « dose de ventilation » excessive favorise les efforts inefficaces, mais un réglage optimal du ventilateur permet de minimiser ces asynchronies. Cette thèse est un support pour déterminer dans une étude plus large si une synchronisation adéquate peut réduire la durée de ventilation. / Major patient-ventilator asynchrony seems common on ventilator screen during assisted mechanical ventilation. Objectives: To evaluate the incidence of major asynchrony and to identify factors related to patient's characteristics and ventilator parameters associated with asynchrony, and to determine optimal ventilator adjustments. Methods: We evaluated the incidence of major patterns of asynchrony easily detected using a noninvasive method based on flow and airway pressure curves. In patients with frequent ineffective efforts we measured patient's effort using esophageal pressure measurements to optimize ventilatory settings. We evaluated the impact of ventilatory mode on sleep quality using a complete polysomnography. All intensive-care-unit ventilators were compared on a bench test in terms of trigger performance and pressurization capacity. Results: One-fourth of intubated patients exhibited major asynchrony. Duration of mechanical ventilation was longer and weaning more difficult in patients with asynchrony as compared to patients without asynchrony. Ineffective triggering was the main pattern of asynchrony and was promoted by excessive ventilatory assistance. Reducing the pressure-support completely eliminated ineffective efforts in most of patients, without inducing excessive respiratory muscle effort and without modifying the true patient's respiratory rate. Ventilatory mode did not influence sleep quality and asynchrony. Ineffective efforts were detected during both pressure-support ventilation and assist-control ventilation, and central apneas were not common using adequate level of pressure-support. Some ventilators exhibited poor performances which could promote patient-ventilator asynchrony. Conclusion: Patient-ventilator asynchrony is frequent during assisted ventilation and associated with prolonged duration of mechanical ventilation. Excessive ventilatory support could promote ineffective efforts although optimal ventilatory settings could minimize asynchrony. This work is a starting point to determine in a large study, whether optimization of ventilatory settings could shorten duration of mechanical ventilation.

No description available.

Orientador: Renato Guiseppe Terzi / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T22:34:54Z (GMT). No. of bitstreams: 1 Ferreira_JulianaHeloisaTerra_M.pdf: 2639255 bytes, checksum: fcee62586088020b3a17254a5a9df91f (MD5) Previous issue date: 2006 / Resumo: A literatura aborda de forma muito ampla os mecanismos responsáveis pela gênese da hipoxemia no tromboembolismo pulmonar (TEP). O objetivo deste estudo foi analisar quais os mecanismos que contribuíram para a hipoxemia em um modelo de TEP agudo experimental. A embolização com coágulos autólogos foi realizada em sete porcos com peso de 24,00±0,6 kg, anestesiados e mecanicamente ventilados na modalidade controlada, com fração de oxigênio no ar inspirado (FiO2) de 0,21. A análise do intercâmbio gasoso foi realizada pela correlação entre a gasometria arterial e a capnografia volumétrica. Foi observada uma significativa redução das pressões parciais de oxigênio tanto no sangue arterial quanto no ar alveolar calculada pela equação do ar alveolar. A ventilação alveolar efetiva apresentou significativa redução, evidenciando a consistente queda do volume de gás alveolar que efetivamente participou das trocas gasosas (VAef). A relação entre a ventilação alveolar que efetivamente participou das trocas gasosas e o débito cardíaco (V¿Aef/Q¿), também apresentou uma redução significativa após a embolização. Embora a pressão parcial de dióxido de carbono (CO2) no sangue arterial aumente significativamente, a pressão parcial de CO2 no final da expiração (PetCO2) apresentou significativa redução, retornando ao basal aos quarenta minutos após a embolia. Conseqüentemente, a diferença artério-alveolar de pressão parcial de dióxido de carbono (P(a-et)CO2) aumentou significativamente. Houve um aumento de espaço morto alveolar e fisiológico. Concluímos, com base nos dados obtidos que a grave hipoxemia arterial observada pode ser explicada por redução da pressão alveolar de oxigênio, além da redução da ventilação alveolar efetiva e da razão V¿Aef/Q¿. Também demonstramos que a razão V¿Aef/Q¿ aumentou progressivamente depois da embolização, um fato atribuído, ou por lise dos trombos, ou por redistribuição da ventilação alveolar induzida por broncoconstrição hipocápnica / Abstract: The literature broadly approaches the mechanisms responsible for the genesis of the hypoxemia in pulmonary embolism (PE). The aim of this study is to analyze the ventilation/perfusion ratio, which contributed to the hypoxemia in PE by analyzing blood gases and volumetric capnography in a model of experimental acute PE. Pulmonary embolization with autologous blood clots was carried out in seven pigs weighing 24.00±0.6Kg, anesthetized and mechanically ventilated. A significant reduction in the oxygen partial pressures was observed in both, the arterial blood and alveolar air. The effective alveolar ventilation exhibited a significant reduction consistent with the fall in the alveolar gas volume that effectively participated in gas exchange. The relation between the alveolar ventilation that effectively participated in gas exchange and cardiac output (V¿Aeff/Q¿ ratio) also presented a significant reduction after embolization. The carbon dioxide partial pressure increased significantly in the arterial blood (PaCO2), but decreased significantly in the exhaled air at the end of the respiratory cycle (PetCO2). PetCO2 returned to baseline values forty minutes after embolism. The arterial to alveolar carbon dioxide gradient (P(a-et)CO2), increased significantly, as well as the calculated alveolar and physiological dead spaces. We conclude, based on our data, that the severe arterial hypoxemia observed in this experimental model may be attributed to the reduction of the effective alveolar ventilation ratio (V¿Aeff/Q¿). We were also able to demonstrate that V¿Aeff/Q¿ progressively improves after embolization, a fact attributed to the lysis of thromby or by alveolar ventilation redistribution induced by hypocapnic bronchoconstriction / Mestrado / Pesquisa Experimental / Mestre em Cirurgia