Alveolar recruitment versus hyperinflation: a balancing act

  title={Alveolar recruitment versus hyperinflation: a balancing act},
  author={Ron Dueck},
  journal={Current Opinion in Anaesthesiology},
  • R. Dueck
  • Published 1 December 2006
  • Medicine
  • Current Opinion in Anaesthesiology
Purpose of review To address lung recruitment according to pressure/volume curves, along with regional recruitment versus hyperinflation evidence from computed tomography and electrical impedance tomography. Recent findings Cyclical tidal volume recruitment of atelectatic lung regions causes acute lung injury, as do large breaths during pneumonectomy. Using the lower inflection point on the static pressure/volume inflation curve plus 2 cmH2O as a positive end-expiratory pressure setting limits… 

Regional respiratory inflation and deflation pressure–volume curves determined by electrical impedance tomography

Comparison of the EIT-derived regional PV curves in ventral, middle and dorsal regions of the right and left lungs showed not only different amounts of hysteresis in these regions but also marked differences among different landmark pressures calculated on the inflation and deflation limbs of the curves.

Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury

Reduction in PEEP consistently enhanced poorly or non-aerated areas as well as tidal re-aeration and monitoring respiratory mechanics during a PEEP titration procedure may be a useful adjunct to optimize lung aeration.

Quantification of Alveolar Recruitment for the Optimization of Mechanical Ventilation Using Quasi-Static Pressure Volume Curve

Quasi-static, pulmonary pressure-volume (P-V) curves over an inflation-deflation cycle are analyzed using a respiratory system model (RSM), which had been developed for quantitative characterization

Lung recruitment tools

Clinical and experimental studies has been conducted to identify the durability of the beneficial effects of recruitment manoeuvres, when and how to perform them, early or late in the course of acute respiratory distress syndrome and with high or low PEEP, and which categories of patients will benefit from them.

Optimizing Perioperative Ventilation Support with Adequate Settings of Positive End-Expiratory Pressure

This chapter focuses on controlled mechanical ventilation, under which the patient is not able to trigger a valid breath and the ventilator overtakes all the workload of respiratory muscles.

Interaction of dependent and non-dependent regions of the acutely injured lung during a stepwise recruitment manoeuvre

EIT imaging of regional lung mechanics reveals that overdistension in the non-dependent region precedes atelectasis reversal in the dependent region during a stepwise recruitment manoeuvre.

Acute Lung Injury and Acute Respiratory Distress Syndrome

The new consensus Berlin definition addresses the limits of the AECC definition, by excluding the ALI term, removing the PAOP criteria, introducing PEEP level criteria and including the use of computed tomography images and bedside echocardiography for the assessment of the pulmonary edema.



Positive end-expiratory pressure prevents lung mechanical stress caused by recruitment/derecruitment.

Recruitment followed by ZEEP was more deleterious in ALI than in mechanical ATEL, although ZEEP alone did not elevate PCIII expression.

Slow moderate pressure recruitment maneuver minimizes negative circulatory and lung mechanic side effects: evaluation of recruitment maneuvers using electric impedance tomography

In a lavage model of acute lung injury alveolar recruitment can be achieved with a slow lower pressure recruitment maneuver with less circulatory depression and negative lung mechanic side effects than with higher pressure recruitment maneuvers.

Inspiratory vs. expiratory pressure-volume curves to set end-expiratory pressure in acute lung injury

PEEP according to the expiratory point of maximum curvature was related to an improvement in oxygenation, increase in normally aerated, decrease in nonaerated lung volumes, and greater alveolar stability.

The Effects of the Alveolar Recruitment Maneuver and Positive End-Expiratory Pressure on Arterial Oxygenation During Laparoscopic Bariatric Surgery

The data suggest that the use of alveolar recruitment may be an effective mode of improving intraoperative oxygenation in morbidly obese patients and shows the effect to be short lived and associated with more frequent intraoperative use of vasopressors.

Mechanical ventilation in acute respiratory failure: recruitment and high positive end-expiratory pressure are necessary

Both conventional and electrical impedance thoracic tomography studies indicate that stepwise PEEP recruitment maneuvers increase lung volume and the recruitment percentage of lung tissue, and higher levels of PEEP are necessary to maintain the lungs open and assure homogenous ventilation in ARDS.

High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure.

To the authors' knowledge, this constitutes the first example of a protective effect of PEEP during permeability edema, which was markedly reduced by PEEP and preserved the normal ultrastructural aspect of the alveolar epithelium.

Computed tomography scan assessment of lung volume and recruitment during high-frequency oscillatory ventilation

Experimental data suggest that HFOV at mean airway pressures (mPaw) set according to a static PV curve leads to effective lung recruitment but results in overall lung volumes that are considerably higher than those predicted from the PV relationship.

Recruitment maneuvers attenuate repeated derecruitment-associated lung injury

It is suggested that repeated de Recruitments could induce lung injuries during mechanical ventilation, and recruitment maneuvers may attenuate derecruitment-associated lung injuries.

Effects of Positive End‐expiratory Pressure on Gas Exchange in Dogs with Normal and Edematous Lungs

In dogs with pulmonary edema, PEEP's of 5 and 10cm H2O resulted in dramatic reductions in shunt, virtual obliteration of low VA/Q regions, and marked improvement in PaO2, however, at 15 and 20 cm H 2O PEEPs, high VA/ Q and dead space ventilation with CO2 retention developed in all but the most severely affected dogs.

Effects of Positive End-expiratory Pressure on Gas Exchange in Dogs with Normal and Edematous Lungs

In dogs with pulmonary edema, PEEP's of 5 and 10 cm H2O resulted in dramatic reductions in shunt, virtual obliteration of low VA/Q regions, and market improvement in Pao2, however, at 15 and 20 cm H 2O PEP's highVA/Q and dead space ventilation with CO2 retention again developed in all but the most severely affected dogs.