Lung recruitment maneuver: Difference between revisions

Revision as of 06:26, 13 April 2016

Controversial in terms of safety and efficacy
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, perhaps also improving respiratory acidosis
- Decrease ventilator-induced lung injury

Authors:

@@ Line 6: / Line 6: @@
 *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
+**Dependent areas of airway are collapsed throughout TVs
-**Intermediate/cyclic collapse causing shear injury atelectrauma with each breath
+**Cyclic collapse causes shear injury atelectrauma with each breath
-**Least dependent areas inflated throughout TV are also easily hyperinflated causing volutrauma and barotrauma in:
+**Least dependent areas inflated throughout TVs are also easily hyperinflated causing volutrauma and barotrauma, especially in:
 ***TVs > 6 cc/kg
 ***Pplat > 30-35 cmH2O