Functional residual capacity-guided alveolar recruitment strategy after endotracheal suctioning in cardiac surgery patients

Abstract

By measurements of functional residual capacity after endotracheal suctioning, patients profiting from a consecutive recruitment maneuver could be identified. Guiding the recruitment strategy on changes of functional residual capacity may improve patient care.

Decreasing the Adverse Effects of Endotracheal Suctioning During Mechanical Ventilation by Changing Practice

“…23,[29][30][31] Recruitment maneuvers were used in case of persisting hypoxemia after suctioning. 4,32 A sterile technique was employed at all times. The subject's appearance (eg, sweating, skin color, agitation), vital signs (oxygen saturation, heart rate, cardiac rhythm, arterial blood pressure), and ventilatory parameters (breathing frequency, tidal volume, peak inspiratory pressure) were monitored during the whole suctioning procedure.…”

Assessment of intraoperative microaspiration: does a modified cuff shape improve sealing?

“…Several other factors may interfere with respect to the development of post-operative pneumonia: hypoventilation and collapse of lung segments after intubation with subsequent development of atelectasis, absence of recruitment of collapsed alveoli, colonisation and inflammation, and finally infection. Atelectasis itself may be aggravated by oxygen-rich air insufflation, inducing resorption atelectasis, 32 suctioning in the ETT, 33 and direct compression during operation. 34 Finally, in long-term ventilated patients, disruption of mucosal integrity will reduce mucociliary clearance of secretions and induce biofilm formation, with further bacterial colonization inside the ETT enhancing the collapsibility of the alveoli.…”

The Effect of Alveolar Dead Space on the Measurement of End-Expiratory Lung Volume by Modified Nitrogen Wash-Out/Wash-In in Lavage-Induced Lung Injury

“…Determination of end-expiratory lung volume (EELV) can help to monitor severity of acute lung injury 1 ; to assess respiratory mechanics, such as specific lung compliance, 2 lung strain, 3,4 and alveolar recruitment [5][6][7] ; to guide lungprotective ventilation 8 -10 ; and to identify patients who profit from recruitment maneuver after endotracheal suctioning. 11 Despite its critical role in the management of critically ill patients, EELV measurement is not without difficulties, especially in ventilated patients. Quantitative analysis of pulmonary computed tomography (CT) at end-expiration is the gold standard for EELV measurement.…”