Recruitment maneuvers for acute respiratory distress syndrome: the panorama in 2016

Silva, Pedro L.; Pelosi, Paolo; Rocco, Patrícia Rieken Macêdo

doi:10.5935/0103-507x.20160023

Cited by 3 publications

(5 citation statements)

References 18 publications

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“…A recruitment manoeuvre (RM) uses a dynamic and transient increase in the trans-pulmonary pressure to open non-aerated or poorly aerated lung areas [62]. The benefit of improved oxygenation may be offset by a potential epithelial and endothelial cell damage and increased alveolar-capillary permeability [63, 64].…”

Section: Practical Implications At the Bedside And Respiratory Managementioning

confidence: 99%

Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know

Regli

Pelosi

Malbrain

2019

Ann. Intensive Care

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The incidence of intra-abdominal hypertension (IAH) is high and still underappreciated by critical care physicians throughout the world. One in four to one in three patients will have IAH on admission, while one out of two will develop IAH within the first week of Intensive Care Unit stay. IAH is associated with high morbidity and mortality. Although considerable progress has been made over the past decades, some important questions remain regarding the optimal ventilation management in patients with IAH. An important first step is to measure intra-abdominal pressure (IAP). If IAH (IAP > 12 mmHg) is present, medical therapies should be initiated to reduce IAP as small reductions in intra-abdominal volume can significantly reduce IAP and airway pressures. Protective lung ventilation with low tidal volumes in patients with respiratory failure and IAH is important. Abdominal-thoracic pressure transmission is around 50%. In patients with IAH, higher positive end-expiratory pressure (PEEP) levels are often required to avoid alveolar collapse but the optimal PEEP in these patients is still unknown. During recruitment manoeuvres, higher opening pressures may be required while closely monitoring oxygenation and the haemodynamic response. During lung-protective ventilation, whilst keeping driving pressures within safe limits, higher plateau pressures than normally considered might be acceptable. Monitoring of the respiratory function and adapting the ventilatory settings during anaesthesia and critical care are of great importance. This review will focus on how to deal with the respiratory derangements in critically ill patients with IAH.

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Section: Practical Implications At the Bedside And Respiratory Managementioning

confidence: 99%

Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know

Regli

Pelosi

Malbrain

2019

Ann. Intensive Care

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“…Concerning the detrimental effects associated with RM, the risk of barotrauma was not increased (four trials; RR, 0.84; 95% CI, 0.46–1.55) as well as hemodynamic compromise (three trials; RR, 1.30; 95% CI, 0.92–1.78) [64] . Different lung RMs have been used: sustained high airway pressure for a limited amount of time, stepwise increase in PEEP with fixed driving pressure, and others 65 , [66] , [67] , [68] , and this heterogeneity may limit the accuracy of meta-analysis.…”

Section: Rule 4 Recruitment Maneuversmentioning

confidence: 99%

“…In phenotype 2, we suggest using moderate-to-high PEEP levels to improve lung recruitment; rescue therapies can be considered. In phenotype 3, we suggest using current recommendations for typical (non-COVID) ARDS [ [24] , 25 , [26] , [27] , [28] , 29 , [30] , [31] , [32] , [33] , [34] , [35] , 36 , [37] , [38] , [39] , 40 , [41] , [42] , [43] , [44] , [45] , 46 , [47] , [48] , [49] , [50] , [51] , 52 , [53] , [54] , [55] , 56 , [57] , 58 , [59] , [60] , [61] , [62] , [63] , [64] , 65 , [66] , [67] , [68] , 69 , [70] , [71] , [72] , [73] , [74] , [75] , 76 , [77] , [78] , [79] , [80] , [81] , [82] , 83 , 84 , [85] , [86] , 87 , [88] , [89] ,…”

Section: Coronavirus Disease 2019 (Covid-19) Ardsmentioning

confidence: 99%

Ten golden rules for individualized mechanical ventilation in acute respiratory distress syndrome

Battaglini

Sottano

Ball

et al. 2021

Journal of Intensive Medicine

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Over the last decades, great strides have been made in the management of acute respiratory distress syndrome (ARDS). Mechanical ventilation remains the cornerstone of supportive therapy for ARDS. Lung-protective mechanical ventilation minimizes the risk of ventilator-induced lung injury (VILI) and improves survival. Several parameters are determinants of VILI and require careful setting, such as tidal volume (V T ), plateau pressure (Pplat), driving pressure (DP), positive end-expiratory pressure (PEEP), and respiratory rate. Furthermore, measurement of energy and mechanical power may enable quantification of the relative contribution of its different components (V T , Pplat, ΔP, PEEP, respiratory rate, and airflow) and better individualize mechanical ventilation settings. The use of neuromuscular blocking agents is of interest, mainly in cases of severe ARDS, to improve oxygenation and reduce asynchrony; however, no significant changes in survival have been observed. Rescue respiratory therapies, such as prone positioning, inhaled nitric oxide, and extracorporeal support techniques may also be used in specific situations. Furthermore, respiratory weaning protocols should be discussed. After reviewing all recent clinical trials, we now present 10 golden rules to individualize mechanical ventilation in ARDS management.

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“…RMs are transient increases in transpulmonary pressure that may open non-aerated or poorly aerated areas of the lung, while concomitantly increasing the risk of endothelial-cell damage and increased capillary permeability ( Silva et al, 2016 ). Although alveolar recruitment can be obtained through a variety of techniques during mechanical ventilation in critically ill patients in general, whether alveolar RMs should be used at all has been widely debated.…”

Section: Chest Physiotherapy For Mechanically Ventilated Covid-19 Patmentioning

confidence: 99%

“…A recent study in critically ill patients demonstrated that using positive-pressure ventilation before extubation reduced the incidence of major complications ( Andreu et al, 2019 ). Alveolar RMs, when feasible and necessary, may be considered before extubation to reduce alveolar derecruitment ( Silva et al, 2016 ).…”

Section: Chest Physiotherapy For Mechanically Ventilated Covid-19 Patmentioning

confidence: 99%

Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19

Battaglini

Robba

Caiffa

et al. 2020

Respiratory Physiology & Neurobiology

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Highlights Physiotherapy may help prevent or mitigate sequelae related to bed rest, thus improving physical function and outcomes and reducing length of stay by increasing ventilator free-days. Before starting chest physiotherapy, we recommend the use of adequate personal protective equipment, limiting healthcare workers in the room to one physician and one physiotherapist, as well as choosing a negative-pressure chamber if available. Chest physiotherapy should be tailored to the specific phenotype of COVID-19 patients. Patients who might be eligible for a spontaneous breathing trial should receive chest physiotehrapy before and after extubation. NIV, CPAP, and HFNO should also be considered for short periods after extubation, until complete respiratory autonomy is reached.

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Recruitment maneuvers for acute respiratory distress syndrome: the panorama in 2016

Cited by 3 publications

References 18 publications

Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know

Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know

Ten golden rules for individualized mechanical ventilation in acute respiratory distress syndrome

Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19

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