Alveolar recruitment maneuvers in respiratory distress syndrome

Algaba, Ángela; Nin, Nicolás

doi:10.1016/j.medine.2013.01.006

Cited by 8 publications

(6 citation statements)

References 57 publications

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“…The LRMs’ effects might depend on the pressure level reached and/or the duration of exposure. The level of pressure needed to open atelectactic lung cannot be calculated precisely, and 40 cmH 2 O might not suffice [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Respiratory effects of lung recruitment maneuvers depend on the recruitment-to-inflation ratio in patients with COVID-19-related acute respiratory distress syndrome

et al. 2022

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Background In the context of acute respiratory distress syndrome (ARDS), the response to lung recruitment maneuvers (LRMs) varies considerably from one patient to another and so is difficult to predict. The aim of the study was to determine whether or not the recruitment-to-inflation (R/I) ratio could differentiate between patients according to the change in lung mechanics during the LRM. Methods We evaluated the changes in gas exchange and respiratory mechanics induced by a stepwise LRM at a constant driving pressure of 15 cmH2O during pressure-controlled ventilation. We assessed lung recruitability by measuring the R/I ratio. Patients were dichotomized with regard to the median R/I ratio. Results We included 30 patients with moderate-to-severe ARDS and a median [interquartile range] R/I ratio of 0.62 [0.42–0.83]. After the LRM, patients with high recruitability (R/I ratio ≥ 0.62) presented an improvement in the PaO2/FiO2 ratio, due to significant increase in respiratory system compliance (33 [27–42] vs. 42 [35–60] mL/cmH2O; p < 0.001). In low recruitability patients (R/I < 0.62), the increase in PaO2/FiO2 ratio was associated with a significant decrease in pulse pressure as a surrogate of cardiac output (70 [55–85] vs. 50 [51–67] mmHg; p = 0.01) but not with a significant change in respiratory system compliance (33 [24–47] vs. 35 [25–47] mL/cmH2O; p = 0.74). Conclusion After the LRM, patients with high recruitability presented a significant increase in respiratory system compliance (indicating a gain in ventilated area), while those with low recruitability presented a decrease in pulse pressure suggesting a drop in cardiac output and therefore in intrapulmonary shunt.

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Section: Discussionmentioning

confidence: 99%

Respiratory effects of lung recruitment maneuvers depend on the recruitment-to-inflation ratio in patients with COVID-19-related acute respiratory distress syndrome

et al. 2022

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“…Although there were no complications induced by LRM in this study, there is a risk of adverse events such as severe hypotension, fatal arrhythmia, and pneumothorax with LRM procedure [ 37 , 38 ]. In the current study, the decrease in MAP induced by LRM (responders: 77 to 58 mmHg, nonresponders: 78 to 66 mmHg) were similar with those in the previous study [ 14 ] (LRM was performed in supine position; responders: 71 to 51 mmHg, nonresponders: 71 to 55 mmHg).…”

Section: Discussionmentioning

confidence: 99%

Changes in stroke volume induced by lung recruitment maneuver can predict fluid responsiveness during intraoperative lung-protective ventilation in prone position

et al. 2021

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Background The present study aimed to evaluate the reliability of hemodynamic changes induced by lung recruitment maneuver (LRM) in predicting stroke volume (SV) increase after fluid loading (FL) in prone position. Methods Thirty patients undergoing spine surgery in prone position were enrolled. Lung-protective ventilation (tidal volume, 6–7 mL/kg; positive end-expiratory pressure, 5 cmH2O) was provided to all patients. LRM (30 cmH2O for 30 s) was performed. Hemodynamic variables including mean arterial pressure (MAP), heart rate, SV, SV variation (SVV), and pulse pressure variation (PPV) were simultaneously recorded before, during, and at 5 min after LRM and after FL (250 mL in 10 min). Receiver operating characteristic curves were generated to evaluate the predictability of SVV, PPV, and SV decrease by LRM (ΔSVLRM) for SV responders (SV increase after FL > 10%). The gray zone approach was applied for ΔSVLRM. Results Areas under the curve (AUCs) for ΔSVLRM, SVV, and PPV to predict SV responders were 0.778 (95% confidence interval: 0.590–0.909), 0.563 (0.371–0.743), and 0.502 (0.315–0.689), respectively. The optimal threshold for ΔSVLRM was 30% (sensitivity, 92.3%; specificity, 70.6%). With the gray zone approach, the inconclusive values ranged 25 to 75% for ΔSVLRM (including 50% of enrolled patients). Conclusion In prone position, LRM-induced SV decrease predicted SV increase after FL with higher reliability than traditional dynamic indices. On the other hand, considering the relatively large gray zone in this study, future research is needed to further improve the clinical significance. Trial registration UMIN Clinical Trial Registry UMIN000027966. Registered 28th June 2017.

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“…To distend the lung, in addition to using the PEEP, recruitment manoeuvres are used, although this is still under debate. 13 To develop this PEEP, the use of non-invasive mechanical ventilation is ideal. 9 However, the high number of patients with severe respiratory failure and the lack of non-invasive ventilation devices imposed the use of alternative CPAPs that were capable of producing this PEEP.…”

Section: Discussionmentioning

confidence: 99%

Alternative CPAP methods for the treatment of secondary serious respiratory failure due to pneumonia by COVID-19

Mateos-Rodríguez

Ortega-Anselmi

Candel-González

et al. 2021

Medicina Clínica (English Edition)

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Alveolar recruitment maneuvers in respiratory distress syndrome

Cited by 8 publications

References 57 publications

Respiratory effects of lung recruitment maneuvers depend on the recruitment-to-inflation ratio in patients with COVID-19-related acute respiratory distress syndrome

Respiratory effects of lung recruitment maneuvers depend on the recruitment-to-inflation ratio in patients with COVID-19-related acute respiratory distress syndrome

Changes in stroke volume induced by lung recruitment maneuver can predict fluid responsiveness during intraoperative lung-protective ventilation in prone position

Alternative CPAP methods for the treatment of secondary serious respiratory failure due to pneumonia by COVID-19

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