Lung recruitment maneuver: Difference between revisions
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==Background== | ==Background== | ||
*Controversial in terms of safety and efficacy | *Controversial in terms of safety and efficacy | ||
**No mortality/morbidity outcome benefits | |||
**May be of more benefit to extra-pulmonary ARDS than to pulmonary ARDS | |||
*Multiple methods reported | *Multiple methods reported | ||
**Below is only one method | **Below is only one method | ||
| Line 16: | Line 18: | ||
**High FiO2 absorptive atelectasis | **High FiO2 absorptive atelectasis | ||
*Goals to recruit alveoli and maintain with PEEP to prevent cyclic collapse | *Goals to recruit alveoli and maintain with PEEP to prevent cyclic collapse | ||
**Improving hypoxemia | **Improving hypoxemia | ||
**Decrease [[ventilator-induced lung injury]] | **Decrease [[ventilator-induced lung injury]] | ||
==Procedure== | ==Risks== | ||
*May only be temporary benefit | |||
*Hemodynamic instability with drop off in preload | |||
*CO2 retention | |||
*May worsen oxygenation by shunting blood to poorly aerated lung (opposing physiological hypoxic pulmonary vasoconstriction) | |||
*May worsen [[ventilator-induced lung injury]] with volutrauma/barotrauma | |||
*[[Pneumothorax]] | |||
==Procedure<ref>Medical College of Georgia. Open Lung Tool Procedure Protocol. Updated 2014.</ref>== | |||
===Preparation=== | |||
*May require increased sedation or paralysis | |||
*Optimize preload (maneuver decreases preload) | |||
*[[Pressure control ventilation]] using current rate, PEEP, FiO2 | |||
*Adjust I:E to 1:1 | |||
*Record baseline VSs and vent settings | |||
*14 ga needles x2 in case of [[pneumothorax]] | |||
==Adjuncts== | ==Adjuncts== | ||
*[[Inhaled nitric oxide]] ([[iNO]]) | *[[Inhaled nitric oxide]] ([[iNO]]) | ||
*[[ | *[[Prostacyclins]], [[epoprostenol]] ([[Flolan]]) | ||
*[[ECMO]] | *[[ECMO]] | ||
*[[Oscillation ventilation]], [[High frequency oscillation ventilation]] ([[HFOV]]) | *[[Oscillation ventilation]], [[High frequency oscillation ventilation]] ([[HFOV]]) | ||
Revision as of 07:12, 13 April 2016
Background
- Controversial in terms of safety and efficacy
- No mortality/morbidity outcome benefits
- May be of more benefit to extra-pulmonary ARDS than to pulmonary ARDS
- Multiple methods reported
- Below is only one method
- Refer to your RT for hospital protocol
- Severe ARDS in which PaO2 recalcitrant to maximal ventilator settings, APRV, PCV
- Biotrauma and cytokine release occur due to:
- Dependent areas of airway are collapsed throughout TVs
- Cyclic collapse causes shear injury atelectrauma with each breath
- Least dependent areas inflated throughout TVs are also easily hyperinflated causing volutrauma and barotrauma, especially in:
- TVs > 6 cc/kg
- Pplat > 30-35 cmH2O
- Derecruitment of alveoli occurs due to[1]:
- Standard low TV ventilation in ARDS
- Insufficient PEEP
- High FiO2 absorptive atelectasis
- Goals to recruit alveoli and maintain with PEEP to prevent cyclic collapse
- Improving hypoxemia
- Decrease ventilator-induced lung injury
Risks
- May only be temporary benefit
- Hemodynamic instability with drop off in preload
- CO2 retention
- May worsen oxygenation by shunting blood to poorly aerated lung (opposing physiological hypoxic pulmonary vasoconstriction)
- May worsen ventilator-induced lung injury with volutrauma/barotrauma
- Pneumothorax
Procedure[2]
Preparation
- May require increased sedation or paralysis
- Optimize preload (maneuver decreases preload)
- Pressure control ventilation using current rate, PEEP, FiO2
- Adjust I:E to 1:1
- Record baseline VSs and vent settings
- 14 ga needles x2 in case of pneumothorax
Adjuncts
- Inhaled nitric oxide (iNO)
- Prostacyclins, epoprostenol (Flolan)
- ECMO
- Oscillation ventilation, High frequency oscillation ventilation (HFOV)
See Also
References
- ↑ Nickson C. Lung Recruitment Maneuvers. 21 Sept 2014. http://lifeinthefastlane.com/ccc/recruitment-manoeuvres-in-ards/
- ↑ Medical College of Georgia. Open Lung Tool Procedure Protocol. Updated 2014.