Lung recruitment maneuver

Background

• 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:
  • 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

Adjuncts

• Inhaled nitric oxide (iNO)
• Prostacycline, epoprostenol (Flolan)
• ECMO
• Oscillation ventilation, High frequency oscillation ventilation (HFOV)

See Also

• ARDS
• Mechanical ventilation
• APRV
• PCV
• Ventilator-induced lung injury