Lung recruitment maneuver - Revision history

Rossdonaldson1: /* See Also */

2024-04-24T16:02:34Z

Rossdonaldson1: /* Preparation */

2024-04-24T16:01:53Z

Preparation

← Older revision		Revision as of 16:01, 24 April 2024
Line 54:		Line 54:
	**Adjust FiO2 to SaO2 90-92%		**Adjust FiO2 to SaO2 90-92%
	**Take note of dynamic compliance levels		**Take note of dynamic compliance levels
	**[[Pressure control ventilation]] using current rate, PEEP, FiO2 before maneuver		**Pressure control ventilation using current rate, PEEP, FiO2 before maneuver
	***Adjust PC level above PEEP to start at TV of 6 cc/kg for 2 minutes		***Adjust PC level above PEEP to start at TV of 6 cc/kg for 2 minutes
	***Then set PC level (Pi) to 15 cmH2O above PEEP and maintain this difference throughout initial recruitment		***Then set PC level (Pi) to 15 cmH2O above PEEP and maintain this difference throughout initial recruitment

ClaireLewis at 15:33, 27 September 2019

2019-09-27T15:33:35Z

← Older revision		Revision as of 15:33, 27 September 2019
Line 7:		Line 7:
	**Refer to your RT for hospital protocol		**Refer to your RT for hospital protocol
	**Proning patient is considered a recruitment maneuver		**Proning patient is considered a recruitment maneuver
	*'''Indication:''' severe ARDS < 1 wk, before onset of fibro-proliferation<ref>Habashi, NM et al. New Directions in Ventilatory Management from: Advanced Therapy in Thoracic Surgery Chapter 3. pp 24-35. Franco KL, Putnam JB. 1998.</ref><ref>Richards G et al. Oct 2006 last updated. http://www.anaesthetist.com/icu/organs/lung/recruit/Findex.htm.</ref>		*'''Indication:''' severe [[ARDS]] < 1 wk, before onset of fibro-proliferation<ref>Habashi, NM et al. New Directions in Ventilatory Management from: Advanced Therapy in Thoracic Surgery Chapter 3. pp 24-35. Franco KL, Putnam JB. 1998.</ref><ref>Richards G et al. Oct 2006 last updated. http://www.anaesthetist.com/icu/organs/lung/recruit/Findex.htm.</ref>
	*Goals to recruit alveoli, maintain with PEEP at the derecruitment point, prevent cyclic collapse/VILI		*Goals to recruit alveoli, maintain with PEEP at the derecruitment point, prevent cyclic collapse/VILI
	**Improving hypoxemia via recruitment		**Improving hypoxemia via recruitment
Line 24:		Line 24:
	==Risks==		==Risks==
	*May only be temporary benefit		*May only be temporary benefit
	*Hemodynamic instability with drop off in preload		*[[shock\|Hemodynamic instability]] with drop off in preload
	*CO2 retention		*[[hypercapnia\|CO2 retention]]
	*May worsen oxygenation by shunting blood to poorly aerated lung (opposing physiological hypoxic pulmonary vasoconstriction)		*May worsen oxygenation by shunting blood to poorly aerated lung (opposing physiological hypoxic pulmonary vasoconstriction)
	*May worsen [[ventilator-induced lung injury]] with volutrauma/barotrauma		*May worsen [[ventilator-induced lung injury]] with volutrauma/barotrauma
Line 31:		Line 31:
	*Contraindications		*Contraindications
	**Unstable BP		**Unstable BP
	**pneumothorax or high risk of pneumothorax (blebs, necrotising pneumonia)		**[[pneumothorax]] or high risk of pneumothorax (blebs, necrotising pneumonia)
	**ARDS > 1 wk (relative contraindication)		**[[ARDS]] > 1 wk (relative contraindication)

	==Procedure<ref>Medical College of Georgia. Open Lung Tool Procedure Protocol. Updated 2014.</ref>==		==Procedure<ref>Medical College of Georgia. Open Lung Tool Procedure Protocol. Updated 2014.</ref>==
Line 41:		Line 41:
	**HR < 60 bpm		**HR < 60 bpm
	**HR > 140 bpm		**HR > 140 bpm
	**New dysrhythmia on monitor (may indicate significant respiratory acid-base shift)		**New [[dysrhythmia]] on monitor (may indicate significant respiratory acid-base shift)
	**SBP < 80 mmHg		**SBP < 80 mmHg
	**Sustained SaO2 < 85%		**Sustained SaO2 < 85%
Line 50:		Line 50:
	*Maintain a very reliable, good waveform SpO2 (that matches ABG SaO2)		*Maintain a very reliable, good waveform SpO2 (that matches ABG SaO2)
	*14 ga needles x2 in case of [[pneumothorax]]		*14 ga needles x2 in case of [[pneumothorax]]
	*Record baseline vital ~~signss~~ and initial ventilator settings		*Record baseline vital signs and initial ventilator settings
	**I:E to 1:1		**I:E to 1:1
	**Adjust FiO2 to SaO2 90-92%		**Adjust FiO2 to SaO2 90-92%
Line 83:		Line 83:
	*Return to PEEP level 2-4 cmH2O above '''decruitment point'''		*Return to PEEP level 2-4 cmH2O above '''decruitment point'''
	*Adjust TV 4-6 cc/kg and plateau pressures < 30 cmH2O		*Adjust TV 4-6 cc/kg and plateau pressures < 30 cmH2O
	*Tolerate permissive ~~hypercapnea~~ if pH > 7.15		*Tolerate permissive hypercapnia if pH > 7.15
	*May increase RR up to maximum of 38 bpm		*May increase RR up to maximum of 38 bpm

Mholtz: Text replacement - "OR" to "'''OR'''"

2017-05-30T23:39:58Z

Text replacement - "OR" to "'''OR'''"

← Older revision		Revision as of 23:39, 30 May 2017
Line 76:		Line 76:
	*Until:		*Until:
	**Decrease in SaO2 of 1% from maximum SaO2 observed, which is the '''derecruitment point'''		**Decrease in SaO2 of 1% from maximum SaO2 observed, which is the '''derecruitment point'''
	**OR minimum of 15 cmH2O PEEP reached		**'''OR''' minimum of 15 cmH2O PEEP reached

	===Re-recruitment===		===Re-recruitment===

Mholtz: Text replacement - "-->" to "→"

2017-02-08T20:15:51Z

Text replacement - "-->" to "→"

← Older revision		Revision as of 20:15, 8 February 2017
Line 63:		Line 63:
	*Set PC level to 15 cmH2O above PEEP		*Set PC level to 15 cmH2O above PEEP
	**Maintain this difference between PEEP and PC level (Pi)		**Maintain this difference between PEEP and PC level (Pi)
	**Increase q2 minutes PEEP to 20 ~~-->~~ 30 ~~-->~~ 40 cmH2O		**Increase q2 minutes PEEP to 20 → 30 → 40 cmH2O
	***Pi will reach 55 cmH2O		***Pi will reach 55 cmH2O
	***Note maximum SaO2 obtained		***Note maximum SaO2 obtained
Line 72:		Line 72:

	===Reducing PEEP===		===Reducing PEEP===
	*Reduce q3 minutes PEEP to 25 ~~-->~~ 22.5 ~~-->~~ 20 ~~-->~~ 17.5 cmH2O		*Reduce q3 minutes PEEP to 25 → 22.5 → 20 → 17.5 cmH2O
	*Remember that SpO2 monitor displays results up to 1-2 min after clinical change		*Remember that SpO2 monitor displays results up to 1-2 min after clinical change
	*Until:		*Until:

Mholtz at 05:49, 31 December 2016

2016-12-31T05:49:13Z

← Older revision		Revision as of 05:49, 31 December 2016
Line 87:		Line 87:

	==Adjuncts==		==Adjuncts==
	*[[Inhaled nitric oxide]] ([[iNO]])		*[[Inhaled nitric oxide]] (iNO)
	*[[Epoprostenol (prostacyclin)]] (Flolan)		*[[Epoprostenol (prostacyclin)]] (Flolan)
	*[[~~ECMO~~]]		*[[Extracorporeal membrane oxygenation]]
	*~~[[Oscillation ventilation]],~~ [[High frequency oscillation ventilation]] ([[HFOV]])		*[[High frequency oscillation ventilation]] (HFOV)

	==See Also==		==See Also==
	*[[~~ARDS~~]]		*[[Acute respiratory distress syndrome]]
	*[[Mechanical ventilation]]		*[[Mechanical ventilation (main)]]
	*[[APRV]]		*[[Ventilator associated lung injury]]
	*[[PCV]]
	*[[Ventilator~~-induced~~ lung injury]]

	==References==		==References==

Rossdonaldson1: Text replacement - " vent " to " ventilator "

2016-08-03T16:13:41Z

Text replacement - " vent " to " ventilator "

← Older revision		Revision as of 16:13, 3 August 2016
Line 50:		Line 50:
	*Maintain a very reliable, good waveform SpO2 (that matches ABG SaO2)		*Maintain a very reliable, good waveform SpO2 (that matches ABG SaO2)
	*14 ga needles x2 in case of [[pneumothorax]]		*14 ga needles x2 in case of [[pneumothorax]]
	*Record baseline vital signss and initial ~~vent~~ settings		*Record baseline vital signss and initial ventilator settings
	**I:E to 1:1		**I:E to 1:1
	**Adjust FiO2 to SaO2 90-92%		**Adjust FiO2 to SaO2 90-92%

Rossdonaldson1: Text replacement - "VS" to "vital signs"

2016-08-03T09:30:30Z

Text replacement - "VS" to "vital signs"

← Older revision		Revision as of 09:30, 3 August 2016
Line 50:		Line 50:
	*Maintain a very reliable, good waveform SpO2 (that matches ABG SaO2)		*Maintain a very reliable, good waveform SpO2 (that matches ABG SaO2)
	*14 ga needles x2 in case of [[pneumothorax]]		*14 ga needles x2 in case of [[pneumothorax]]
	*Record baseline ~~VSs~~ and initial vent settings		*Record baseline vital signss and initial vent settings
	**I:E to 1:1		**I:E to 1:1
	**Adjust FiO2 to SaO2 90-92%		**Adjust FiO2 to SaO2 90-92%

Rossdonaldson1: Text replacement - "PTX" to "pneumothorax"

2016-08-01T19:08:33Z

Text replacement - "PTX" to "pneumothorax"

← Older revision		Revision as of 19:08, 1 August 2016
Line 31:		Line 31:
	*Contraindications		*Contraindications
	**Unstable BP		**Unstable BP
	**~~PTX~~ or high risk of ~~PTX~~ (blebs, necrotising pneumonia)		**pneumothorax or high risk of pneumothorax (blebs, necrotising pneumonia)
	**ARDS > 1 wk (relative contraindication)		**ARDS > 1 wk (relative contraindication)

Rossdonaldson1: Rossdonaldson1 moved page Recruitment maneuver to Lung recruitment maneuver

2016-07-28T09:43:31Z

Rossdonaldson1 moved page Recruitment maneuver to Lung recruitment maneuver

← Older revision	Revision as of 09:43, 28 July 2016
(No difference)

← Older revision		Revision as of 16:02, 24 April 2024
Line 94:		Line 94:
	==See Also==		==See Also==
	*[[Acute respiratory distress syndrome]]		*[[Acute respiratory distress syndrome]]
	*[[Mechanical ventilation (main)]]
	*[[Ventilator associated lung injury]]		*[[Ventilator associated lung injury]]

			{{Mechanical ventilation pages}}

	==References==		==References==