Lung recruitment in patients with the acute respiratory distress syndrome.

@article{Gattinoni2006LungRI,
  title={Lung recruitment in patients with the acute respiratory distress syndrome.},
  author={Luciano Gattinoni and Pietro Caironi and Massimo Cressoni and Davide Alberto Chiumello and Vito Marco Ranieri and Michael Quintel and Sebastian Giuseppe Russo and Nicol{\`o} Patroniti and Rodrigo A. Cornejo and Guillermo Bugedo},
  journal={The New England journal of medicine},
  year={2006},
  volume={354 17},
  pages={
          1775-86
        }
}
BACKGROUND In the acute respiratory distress syndrome (ARDS), positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by keeping lung regions open that otherwise would be collapsed. Since the effects of PEEP probably depend on the recruitability of lung tissue, we conducted a study to examine the relationship between the percentage of potentially recruitable lung, as indicated by computed tomography (CT), and the clinical and physiological effects of PEEP. METHODS… 
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Methods Citations
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Lung opening and closing during ventilation of acute respiratory distress syndrome.
TLDR
In patients with acute lung injury or ARDS, especially in patients with higher lung recruitability, the beneficial impact of reducing intratidal alveolar opening and closing by increasing PEEP prevails over the effects of increasingAlveolar strain.
PEEP-induced changes in lung volume in acute respiratory distress syndrome. Two methods to estimate alveolar recruitment
TLDR
PEEP-induced recruitment and strain can be assessed at the bedside using EELV measurement and two bedside methods for predicting low or high alveolar recruitment during ARDS are described.
Lung morphology predicts response to recruitment maneuver in patients with acute respiratory distress syndrome
TLDR
Patients with focal lung morphology are at risk for significant hyperinflation during the recruitment maneuvers, and lung recruitment is rather limited.
Refining ventilatory treatment for acute lung injury and acute respiratory distress syndrome.
TLDR
Two new large international randomized trials examining the effects of PEEP on outcome in patients with ALI and ARDS are presented, and evidence from animal studies suggested that higher PEEP (in the range of 10-15 cm H2O) could prevent VILI.
How large is the lung recruitability in early acute respiratory distress syndrome: a prospective case series of patients monitored by computed tomography
TLDR
MRS could efficiently reverse hypoxemia and most of the collapsed lung tissue during the course of ARDS, compatible with a high lung recruitability in non-selected patients with early, severe ARDS.
Respiratory Mechanics, Lung Recruitability, and Gas Exchange in Pulmonary and Extrapulmonary Acute Respiratory Distress Syndrome
TLDR
In the early stage, pulmonary acute respiratory distress syndrome is characterized by a greater impairment of gas exchange and higher lung recruitability, which is important for a more customized ventilatory management.
The authors reply.
TLDR
Bedside noninvasive radiation-free methods to quantify PLR through changes in end-expiratory lung inflation at different PEEP levels (PLRinfl) have become more widely available and might be regarded as a more comprehensive assessment of the beneficial effects of higher PEEP on the mechanisms leading to VILI.
Quantification of lung recruitment by respiratory mechanics and CT imaging: what are the clinical implications?
TLDR
Recruitment maneuvers have been proposed as useful tools in managing patients with ARDS in order to add previously non-participatory lung units to gas exchange as well as to assess disease severity.
Lung Recruitment Assessed by Respiratory Mechanics and Computed Tomography in Patients with Acute Respiratory Distress Syndrome. What Is the Relationship?
TLDR
Respiratory mechanics-based methods include gas entering in already open pulmonary units that improve their mechanical properties at higher PEEP Consequently, they can be used to assess the overall improvement of inflation.
Lung Recruitability in Severe Acute Respiratory Distress Syndrome Requiring Extracorporeal Membrane Oxygenation.
TLDR
Significant variability in potential for lung recruitment is observed in patients with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation and its relationship with outcomes in this cohort of patients.
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