Effects of sustained inflation and postinflation positive end-expiratory pressure in acute respiratory distress syndrome: Focusing on pulmonary and extrapulmonary forms*

Abstract

Sustained inflation followed by high levels of postinflation positive end-expiratory pressure provided an increase in respiratory system compliance in ARDS; however, arterial oxygenation improved in both ARDS forms.

Paediatric lung recruitment: a review of the clinical evidence

“…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.…”

“…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.…”

“…13 There is a general consensus in the literature that opening of lung units occurs along the entire length of the inspiratory limb of the P-V relationship. [37][38][39][40] The effectiveness of PEEP in recruiting alveolar tissue correlates with the value of the Lower Inflexion Point (LIP). 13,[40][41] A range of ventilators have software suitable to measure P-V curves.…”

Utilidad de las maniobras de reclutamiento (PRO)

“…La respuesta al reclutamiento es variable de un paciente a otro y depende de factores tales como el tipo de lesión (pulmonar o extrapulmonar) 31 , la fase evolutiva (precoz o tardía) 28,29 , la severidad de la lesión, la historia del volumen pulmonar previo, el tipo de MR y el nivel de presión alcanzado 10 . La gama de presiones descrita en los estudios clínicos va desde un mínimo de 40 cmH 2 o necesarios para reexpandir pulmones sanos colapsados tras la inducción anestésica 32 hasta 60 cmH 2 o utilizados en pacientes con SDRA 10,12,33 .…”

“…Grasso et al y oczenski et al observaron que en pacientes con SDRA la respuesta favorable obtenida durante los primeros 2-3 min tras MR se perdía a los 20-30 min tras reinstaurar la ventilación con el nivel de pEEp previo. Ello contrasta con los efectos sostenidos conseguidos en estudios en los que se ajustó el nivel de pEEp tras la MR buscando la prevención del recolapso 10,12,31 .…”