Recruitment by sustained inflation: time for a change

Marini, John J.

doi:10.1007/s00134-011-2329-7

Cited by 34 publications

(15 citation statements)

References 11 publications

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“…In a provocative editorial, Marini 29 suggests that there are good reasons to retire the sustained inflation recruitment maneuver from clinical practice. In its place, he suggests that stepwise approaches are perhaps more effective than abrupt applications of the same peak pressure.…”

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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Section: Types Of Recruitment Maneuversmentioning

confidence: 99%

Recruitment Maneuvers and PEEP Titration

2015

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“…This property is particularly beneficial for use as a lung sealant because proper sealing of lung tissues requires materials that can withstand the high pressures occasionally exerted on pulmonary tissue during invasive mechanical ventilation, for example, by recruitment maneuvers. In this scenario, pressure values can reach up to 40 cmH 2 O of intra-alveolar peak pressure (3.9 kPa) (44).…”

Section: Metro Synthesis and Its Physical Characterizationmentioning

confidence: 99%

Erratum for the Research Article: “Engineering a highly elastic human protein–based sealant for surgical applications” by N. Annabi, Y.-N. Zhang, A. Assmann, E. S. Sani, G. Cheng, A. D. Lassaletta, A. Vegh, B. Dehghani, G. U. Ruiz-Esparza, X. Wang, S. Gangadharan, A. S. Weiss, A. Khademhosseini

2018

Sci. Transl. Med.

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Surgical sealants have been used for sealing or reconnecting ruptured tissues but often have low adhesion, inappropriate mechanical strength, cytotoxicity concerns, and poor performance in biological environments. To address these challenges, we engineered a biocompatible and highly elastic hydrogel sealant with tunable adhesion properties by photocrosslinking the recombinant human protein tropoelastin. The subcutaneous implantation of the methacryloyl-substituted tropoelastin (MeTro) sealant in rodents demonstrated low toxicity and controlled degradation. All animals survived surgical procedures with adequate blood circulation by using MeTro in an incisional model of artery sealing in rats, and animals showed normal breathing and lung function in a model of surgically induced rat lung leakage. In vivo experiments in a porcine model demonstrated complete sealing of severely leaking lung tissue in the absence of sutures or staples, with no clinical or sonographic signs of pneumothorax during 14 days of follow-up. The engineered MeTro sealant has high potential for clinical applications because of superior adhesion and mechanical properties compared to commercially available sealants, as well as opportunity for further optimization of the degradation rate to fit desired surgical applications on different tissues.

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“…However, the literature supports that of these 2 important RM components, pressure has more impact than time. [19][20][21] Many interesting points have been made in the "pressure vs time" debate. Pressure and time are primary factors in recruitment and derecruitment of the alveoli.…”

Section: Ergin öZcan Et Al Effects Of Different Recruitment Maneuvermentioning

confidence: 99%