Abstract
Recruitment maneuvers and the application of high levels of positive end-expiratory pressure combined with lung protective mechanical ventilation strategies have been proposed to improve pulmonary function in patients with severe acute respiratory distress syndrome. However, the optimal way to achieve and maintain alveolar recruitment is still under debate.
Highlights
Recruitment maneuvers and the application of high levels of positive end-expiratory pressure combined with lung protective mechanical ventilation strategies have been proposed to improve pulmonary function in patients with severe acute respiratory distress syndrome
It consists of an initial recruitment phase with stepwise increase of positive end-expiratory pressure (PEEP) and a fixed inspiratory driving pressure until either the lungs are fully recruited, as measured by gas exchange or computed tomography, or peak airway pressures reach 60 cm H2O
Inspiratory plateau pressures in their patient population far exceeded the 28 cm H2O safety limit, which had been associated with increased inflammatory response in a previous study [10], and even the 30 cm H2O cutoff proposed by the acute respiratory distress syndrome (ARDS) Network
Summary
Recruitment maneuvers and the application of high levels of positive end-expiratory pressure combined with lung protective mechanical ventilation strategies have been proposed to improve pulmonary function in patients with severe acute respiratory distress syndrome. The concept of alveolar recruitment and maintenance of high levels of positive end-expiratory pressure (PEEP) was proposed 20 years ago [2]. Recent studies have questioned the concept of lung recruitability in severe ARDS in general and reported high variability of potentially recruitable lung tissue as well as an association with patient response to PEEP [3].
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