Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients

Foti, Giuseppe; Cereda, Maurizio; Sparacino, M. E.; Marchi, Lorenzo De; Villa, Federico; Pesenti, Antonio

doi:10.1007/s001340051196

Cited by 155 publications

(110 citation statements)

References 32 publications

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“…Again, this physiological dynamic has been observed in several clinical studies [e.g. 32,8,22,9,33].…”

Section: Model Validationsupporting

confidence: 55%

“…This effect is especially significant in the ARDS lung because of the reduced number of functional lung units and lower compliance of the overall lung. The benefit of recruitment manoeuvres on ventilated patients is based on this dynamic [32,33]. The same effect results from increasing the PEEP, while keeping the tidal volume the same, causing higher Peak Inspiratory Pressure (PIP).…”

Section: Model Validationmentioning

confidence: 99%

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A minimal model of lung mechanics and model-based markers for optimizing ventilator treatment in ARDS patients

Sundaresan

Yuta

Hann

et al. 2009

Computer Methods and Programs in Biomedicine

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A majority of patients admitted to the Intensive Care Unit (ICU) require some form of respiratory support. In the case of Acute Respiratory Distress Syndrome (ARDS), the patient often requires full intervention from a mechanical ventilator. ARDS is also associated with mortality rate as high as 70%. Despite many recent studies on ventilator treatment of the disease, there are no well established methods to determine the optimal Positive End Expiratory Pressure (PEEP) or other critical ventilator settings for individual patients. A model of fundamental lung mechanics is developed based on capturing the recruitment status of lung units. The main objective of this research is the simplest possible model that is clinically effective in determining PEEP. The model was identified for a variety of different ventilator settings using clinical data. The fitting error was between 0.1% to 4% over the inflation limb and between 0.3% to 13% over the deflation limb at different PEEP settings. The model produces good correlation with clinical data, and is clinically applicable due to the minimal number of patient specific parameters to identify. The ability to use this identified patient specific model to optimize ventilator management is demonstrated by its ability to predict the patient specific response of PEEP changes before clinically applying them. Predictions of recruited lung volume change with change in PEEP have a median absolute error of 1.87% (IQR:0.93-4.80%; 90% CI:0.16-11.98%) for inflation and a median of 5.76% (IQR:2.71-10.50%; 90% CI:0.43-17.04%) for deflation, across all data sets and PEEP values (N = 34 predictions). This minimal model thus provides a clinically useful and simple platform for continuous patient specific monitoring of lung unit recruitment for a patient.

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“…Again, this physiological dynamic has been observed in several clinical studies [e.g. 32,8,22,9,33].…”

Section: Model Validationsupporting

confidence: 55%

Section: Model Validationmentioning

confidence: 99%

A minimal model of lung mechanics and model-based markers for optimizing ventilator treatment in ARDS patients

Sundaresan

Yuta

Hann

et al. 2009

Computer Methods and Programs in Biomedicine

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“…Several studies have evaluated the effect of sighs. [38][39][40][41][42] In the most recent of these, Mauri et al 42 examined the effect of adding a sigh to pressure-support ventilation in 20 critically ill subjects with a P aO 2 /F IO 2 Ͻ300. They used biphasic positive airway pressure at 35 cm H 2 O for 3-4 s at rates of 2 sighs/min, 1 sigh/min, and 1 sigh/2 min.…”

Section: Types Of Recruitment Maneuversmentioning

confidence: 99%

Recruitment Maneuvers and PEEP Titration

2015

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The injurious effects of alveolar overdistention are well accepted, and there is little debate regarding the importance of pressure and volume limitation during mechanical ventilation. The role of recruitment maneuvers is more controversial. Alveolar recruitment is desirable if it can be achieved, but the potential for recruitment is variable among patients with ARDS. A stepwise recruitment maneuver, similar to an incremental PEEP titration, is favored over sustained inflation recruitment maneuvers. Many approaches to PEEP titration have been proposed, and the best method to choose the most appropriate level for an individual patient is unclear. A PEEP level should be selected that balances alveolar recruitment against overdistention. The easiest approach to select PEEP might be according to the severity of the disease: 5-10 cm H 2 O PEEP in mild ARDS, 10 -15 cm H 2 O PEEP in moderate ARDS, and 15-20 cm H 2 O PEEP in severe ARDS. Recruitment maneuvers and PEEP should be used within the context of lung protection and not just as a means of improving oxygenation.

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“…There are several ways to perform ARM, but it basically consists of using high inspiratory pressure for the expansion of collapsed alveoli to increase partial oxygen arterial pressure (PaO 2 ) and high PEEP levels, required to maintain the accrued benefit. (9)(10)(11)(12) The objective is to improve gas exchange by maximum recruitment of alveolar units, to provide a more homogeneous pulmonary parenchyma ventilation. (5) According to the 3 rd Brazilian Consensus on Mechanical Ventilation, ARM has a recommendation level B for ALI/ARDS patients, as there is no consensual opinion on how to perform this maneuver.…”

Section: Alveolar Recruitment Maneuversmentioning

confidence: 99%

Associação das manobras de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo

Costa¹,

Rocha²,

Ribeiro³

2009

Rev. bras. ter. intensiva

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Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients

Abstract: VRMs can improve oxygenation and alveolar recruitment during CPPV at relatively low PEEP, but are relatively less effective than a continuous high PEEP level.

Cited by 155 publications

References 32 publications

A minimal model of lung mechanics and model-based markers for optimizing ventilator treatment in ARDS patients

A minimal model of lung mechanics and model-based markers for optimizing ventilator treatment in ARDS patients

Recruitment Maneuvers and PEEP Titration

Associação das manobras de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo

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