Alveolar recruitment versus hyperinflation: a balancing act

@article{Dueck2006AlveolarRV,
  title={Alveolar recruitment versus hyperinflation: a balancing act},
  author={Ron Dueck},
  journal={Current Opinion in Anaesthesiology},
  year={2006},
  volume={19},
  pages={650–654}
}
  • 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… 

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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

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References

SHOWING 1-10 OF 26 REFERENCES

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.