Lung recruitment maneuver: Difference between revisions

Revision as of 06:13, 13 April 2016

Controversial in terms of safety and efficacy
Severe ARDS in which PaO2 recalcitrant to maximal ventilator settings, APRV, PCV
Biotrauma and cytokine release occur due to:
- Dependent/chronic collapse injury of airways throughout TV
- Intermediate/cyclic collapse causing shear injury atelectrauma with each breath
- Least dependent areas inflated throughout TV, easily hyperinflated causing volutrauma and barotrauma 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, perhaps also improving respiratory acidosis
- Decrease Ventilator-induced lung injury

Authors:

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 ==Background==
+*Controversial in terms of safety and efficacy
 *Severe ARDS in which PaO2 recalcitrant to maximal ventilator settings, APRV, PCV
-*Controversial in terms of safety and efficacy
+*Biotrauma and cytokine release occur due to:
-*Derecruitment of alveoli occurs due to:
+**Dependent/chronic collapse injury of airways throughout TV
+**Intermediate/cyclic collapse causing shear injury atelectrauma with each breath
+**Least dependent areas inflated throughout TV, easily hyperinflated causing volutrauma and barotrauma in:
+***TVs > 6 cc/kg
+***Pplat > 30-35 cmH2O
+*Derecruitment of alveoli occurs due to<ref>Nickson C. Lung Recruitment Maneuvers. 21 Sept 2014. http://lifeinthefastlane.com/ccc/recruitment-manoeuvres-in-ards/</ref>:
 **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, perhaps also improving respiratory acidosis
+**Decrease [[Ventilator-induced lung injury]]
 ==Procedure==