Abstract
Mechanical ventilation is a supportive and life saving therapy in patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). Despite advances in critical care, mortality remains high [1]. During the last decade, the fact that mechanical ventilation can produce morphologic and physiologic alterations in the lungs has been recognized [2]. In this context, the use of low tidal volumes (VT) and limited inspiratory plateau pressure (Pplat) has been proposed when mechanically ventilating the lungs of patients with ALI/ARDS, to prevent lung as well as distal organ injury [3]. However, the reduction in VT may result in alveolar derecruitment, cyclic opening and closing of atelectatic alveoli and distal small airways leading to ventilator-induced lung injury (VILI) if inadequate low positive end-expiratory pressure (PEEP) is applied [4]. On the other hand, high PEEP levels may be associated with excessive lung parenchyma stress and strain [5] and negative hemodynamic effects, resulting in systemic organ injury [6]. Therefore, lung recruitment maneuvers have been proposed and used to open up collapsed lung, while PEEP counteracts alveolar derecruitment due to low VT ventilation [4]. Lung recruitment and stabilization through use of PEEP are illustrated in Figure 1. Nevertheless, the beneficial effects of recruitment maneuvers in ALIIARDS have been questioned. Although Hodgson et al. [7] showed no evidence that recruitment maneuvers reduce mortality or the duration of mechanical ventilation in patients with ALI/ARDS, such maneuvers may be useful to reverse life-threatening hypoxemia [8] and to avoid derecruitment resulting from disconnection and/or airway suctioning procedures [9].
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Pelosi, P., De Abreu, M.G., Rocco, P.R.M. (2010). New and Conventional Strategies for Lung Recruitment in Acute Respiratory Distress Syndrome. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5562-3_15
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DOI: https://doi.org/10.1007/978-1-4419-5562-3_15
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