Lung Recruitment in Trauma Patients

Abstract

The ventilatory management of trauma patients can present significant challenges. Its main aims focus on the reduction of the work of breathing, facilitation of an improvement in gaseous exchange, and on the avoidance of ventilation-induced lung injury (VILI). VILI is a pathophysiologic process consisting of several changes seen in ventilated lungs that have been attributed to the ventilation strategy employed subsequent to the traumatic lung injury. In order to avoid the major components of VILI, both maximal alveolar aeration and recruitment are needed to minimize the shear stresses in the injured lung tissue. Alveolar recruitment maneuvers have become the major goals of mechanical ventilatory support for patients with severe trauma over the last few decades. The importance of early lung recruitment with an 'open lung' approach has been well documented in several studies and its application has been shown to preserve lung mechanics, attenuate lung mechanotrauma, and thereby reduce mortality during ventilation. Controversies nonetheless exist regarding the most appropriate form of their use in patients with pulmonary injuries as recruitment maneuvers may have several adverse effects. The main concerns center on exploiting high airway pressures during the recruitment process and its potential harmful consequences, such as barotrauma and hemodynamic compromise. The purpose of this article is to review the major concepts in the mechanical ventilation literature that outline the principles for the use of the open lung management strategy in patients that have been subjected to significant trauma and to delineate both the major techniques of lung recruitment as well as their potential complications.