Both lung recruitment maneuver and PEEP are needed to increase oxygenation and lung volume after cardiac surgery

Abstract

In patients ventilated after cardiac surgery: (1) PEEP increased lung volume but not PaO2, (2) a lung recruitment maneuver without subsequent PEEP had no sustained effect, and (3) both a lung recruitment maneuver and PEEP were needed to increase and maintain the increased lung volume and PaO2.

Paediatric lung recruitment: a review of the clinical evidence

“…15,16 Incremental increase in both Peak Inspiratory Pressure (PIP) and PEEP has been shown to result in improved gas exchange, tidal volume (V t ), EELV, oxygenation and lung compliance in ventilated adults. [31][32][33][34] Sustained inflations (SI) or inspiratory holds recruit alveoli via a combination of factors -the plateau pressure achieved and the duration of time maintained at that pressure. SI's are reported within the literature as ranging from 25-60cmH 2 O and held for a period of 10-30 seconds.…”

“…14,17,18,20,[35][36][37] This is achieved by using the Continuous Positive Airway Pressure (CPAP) setting on the ventilator, the 'inspiratory hold' feature or manually by using anaesthetic bagging circuits. 17,18,34,36,37 Irrespective of technique, the purpose of the SI is to maintain an elevated plateau pressure for a period of time greater than that achieved with tidal breathing. A few studies have investigated the use of lung recruitment in paediatrics using the SI method.…”

“…13 Other studies have also demonstrated significant improvements in compliance post recruitment and in some instances oxygenation. 33,34,37,38 An alternative lung recruitment strategy is to use the inflexion points of the PressureVolume (P-V) curve derived from ventilatory software. P-V curves can be used as a tool to manage ventilation and recruitment as they describe the viscoelastic characteristics of the lung.…”

“…17 In adults several studies have demonstrated a beneficial effect on oxygenation assuming adequate baseline PEEP is present. 7,20,34,44,55 …”

Manobra de recrutamento alveolar na contusão pulmonar: relato de caso e revisão da literatura

“…ARM is a technique using support pressure increase in the airway to recruit collapsed alveolar units, by increasing the pulmonary area available for gas exchange and therefore arterial oxygenation. (13) It is not only used in patients with ARDS, but also in clinical situations with development of collapsed pulmonary areas (atelectasis). ARM aims to stabilize alveolar permeability which, then must be kept at adequate levels of positive end expiratory pressure (PEEP) that is to say, with lower pressure than that needed for recruitment.…”