Mechanistic scheme and effect of “extended sigh” as a recruitment maneuver in patients with acute respiratory distress syndrome: A preliminary study

Lim, Chae‐Man; Koh, Younsuck; Park, Wann; Chin, Jae Yong; Shim, Tae Sun; Lee, Sang-Deok; Kim, Woo Seob; Kim, Dong S.; Kim, Won D.

doi:10.1097/00003246-200106000-00037

Cited by 84 publications

(68 citation statements)

References 32 publications

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“…In all studies using single or repeated recruitment manoeuvres that showed an increase in P a O 2 the effect was immediate but usually only short lasting [57][58][59][60][61][62][63][64][65][66][67][68]. Only one study on patients receiving mechanical ventilation for less than 72 h showed a prolonged oxygen increase of 60% in 4 h after a single sustained inflation [69].…”

Section: Human Studiesmentioning

confidence: 99%

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Halbertsma¹,

Hoeven

2005

Anaesthesia

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Summary A literature review was conducted to assess the evidence for recruitment manoeuvres used in conventional mechanical positive pressure ventilation. A total of 61 studies on recruitment manoeuvres were identified: 13 experimental, 31 ICU, 6 PICU and 12 anaesthesia studies. Recruitment appears to be a continuous process during inspiration and expiration and is determined by peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP). Single or repeated recruitment manoeuvres may result in a statistically significant increase in oxygenation; however, this is short lasting and clinically irrelevant, especially in late ARDS and pneumonia. Temporary PIP elevation may be effective but only after PEEP loss (for example disconnection and tracheal suctioning). Continuous PEEP elevation and prone positioning can increase Pao2 significantly. Adverse haemodynamic or barotrauma effects are reported in various studies. No data exist on the effect of recruitment manoeuvres on mortality, morbidity, length of stay or duration of mechanical ventilation. Although recruitment manoeuvres can improve oxygenation, they can potentially increase lung injury, which eventually determines outcome. Based on the presently available literature, prone position and sufficient PEEP as part of a lung protective ventilation strategy seem to be the safest and most effective recruitment manoeuvres. As paediatric physiology is essentially different from adult, paediatric studies are needed to determine the role of recruitment manoeuvres in the PICU.

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Section: Human Studiesmentioning

confidence: 99%

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Halbertsma¹,

Hoeven

2005

Anaesthesia

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“…Because the mechanism of hypercarbia in this setting may be an increase in V D /V T , it is possible that monitoring of end-tidal CO 2 alone may be insufficient. Safety of the maneuver may be further enhanced by utilizing regular recovery periods at lower pressures (as utilized by Borges et al 11 ), utilizing lower airway pressures for shorter durations, 13,26 or by use of a larger driving pressure (peak inspiratory pressure minus PEEP) during the maneuver. The use of esophageal pressure monitoring to quantify transpulmonary pressure 27 may also enhance the safety profile of SRS.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 2 Lung Recruitment Strategies in Children With Acute Lung Injury

Kheir¹,

Walsh

Smallwood

et al. 2012

Respir Care

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BACKGROUND: Lung recruitment maneuvers are frequently used in the treatment of children with lung injury. Here we describe a pilot study to compare the acute effects of 2 commonly used lung recruitment maneuvers on lung volume, gas exchange, and hemodynamic profiles in children with acute lung injury. METHODS: In a prospective, non-randomized, crossover pilot study, 10 intubated pediatric subjects with lung injury sequentially underwent: a period of observation; a sustained inflation ( Arterial blood gases, lung mechanics, hemodynamics, and functional residual capacity were recorded following each step of the study and following each increment of the SRS. Both SI and SRS were effective in raising P aO 2 and functional residual capacity. During the SRS maneuver we noted significant increases in dead-space ventilation, a decrease in carbon dioxide elimination, an increase in P aCO 2 , and a decrease in compliance of the respiratory system. Lung recruitment was not sustained following the decremental PEEP titration. CONCLUSIONS: SRS is effective in opening the lung in children with early acute lung injury, and is hemodynamically well tolerated. However, attention must be paid to P aCO 2 during the SRS. Even minutes following lung recruitment, lungs may derecruit when PEEP is lowered beyond the closing pressure.

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“…Performing recruitment manoeuvres is a strategy that aims at briefly increasing the plateau pressure above 30 cmH 2 O in order to overcome the critical opening pressures of the lung units. There are different methods to recruit the lung, as sighs [26], sustained inflation [27], extended-sighs [28]. After the recruitment manoeuvre, a sufficient amount of PEEP should be set to maintain the recruitment.…”

Section: Recruitment Manoeuvresmentioning

confidence: 99%

What is and how to Manage the Acute Respiratory Distress Syndrome?

Guérin¹,

Richard²

2010

TONMEDJ

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Acute respiratory distress syndrome (ARDS) is an acute hypoxemic respiratory failure with lung oedema of non cardiac origin. Its primary treatment is mechanical ventilation. ARDS is under the spotlights with influenza A pandemic flu. An operating definition has been set out by an experts-consensus conference in order to include patients in clinical trials. However, this definition lacks diagnostic accuracy when compared with lung pathology. The conventional mechanical ventilation has two main objectives: firstly, preservation of arterial blood oxygenation, and secondly, protection of the lung from excessive volume or pressure at the end of inspiration. It has been demonstrated that high tidal volume can increase mortality as compared to low tidal volume. The setting of positive end-expiratory pressure (PEEP) is still not solved. Three large randomized controlled trials failed to demonstrate any benefit between a high and a low level of PEEP. A fascinating strategy of mechanical ventilation is lung recruitment, which is defined as an increase in aerated lung mass by reducing non-aerated or poorly aerated lung mass. Recruiting the lung is useful because it can improve oxygenation and limit ventilator-induced lung injury. Lung recruitment depends not only on the ventilatory settings but also on lung and patient. Several adjunct treatments can be used, as prone position or various pharmacological interventions (inhaled nitric oxide). There are several non conventional methods to deliver mechanical ventilation, such as non invasive mechanical ventilation, liquid ventilation, none of them being recommended to date. Finally, the use of extracorporeal lung support is gaining further interest.

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Mechanistic scheme and effect of “extended sigh” as a recruitment maneuver in patients with acute respiratory distress syndrome: A preliminary study

Cited by 84 publications

References 32 publications

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Comparison of 2 Lung Recruitment Strategies in Children With Acute Lung Injury

What is and how to Manage the Acute Respiratory Distress Syndrome?

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