Skip to main content
SpringerLink
Log in

Recruitment Maneuvers and Higher PEEP, the So-Called Open Lung Concept, in Patients with ARDS

  • Chapter
  • First Online:
Annual Update in Intensive Care and Emergency Medicine 2019

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

Abstract

The acute respiratory distress syndrome (ARDS) is a hypoxemic syndrome primarily treated using supportive mechanical ventilation. Although mechanical ventilation is life-saving, it can cause ventilator-induced lung injury (VILI). Therefore, the goal of mechanical ventilation is to achieve adequate gas exchange while minimizing lung injury. Multiple mechanical ventilation strategies have been developed to limit VILI. These strategies are based on the pathophysiological concept that alveolar overdistention, shear-stress, and atelectrauma (i.e., the cyclical opening and closing of unstable alveoli) are possible mechanisms that result in VILI. Targets that might aggravate or attenuate VILI, notably tidal volume and positive end-expiratory pressure (PEEP), have become the subject of extensive research.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Brower R, Matthay M, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342:1301–8.

    Article  Google Scholar 

  2. Lachmann B. Open up the lung and keep the lung open. Intensive Care Med. 1992;18:319–21.

    Article  CAS  Google Scholar 

  3. Protti A, Andreis DT, Monti M, et al. Lung stress and strain during mechanical ventilation: any difference between statics and dynamics? Crit Care Med. 2013;41:1046–55.

    Article  Google Scholar 

  4. Jain SV, Kollisch-Singule M, Satalin J, et al. The role of high airway pressure and dynamic strain on ventilator-induced lung injury in a heterogeneous acute lung injury model. Intensive Care Med Exp. 2017;5:25.

    Article  Google Scholar 

  5. Briel M, Meade M, Mercat A, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010;303:865–73.

    Article  CAS  Google Scholar 

  6. Lu J, Wang X, Chen M, et al. An open lung strategy in the management of acute respiratory distress syndrome: a systematic review and meta-analysis. Shock. 2017;48:43–53.

    Article  Google Scholar 

  7. Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372:747–55.

    Article  CAS  Google Scholar 

  8. Cavalcanti AB, Suzumura EA, Laranjeira LN, et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2017;318:1335–45.

    Article  Google Scholar 

  9. Cipulli F, Vasques F, Duscio E, Romitti F, Quintel M, Gattinoni L. Atelectrauma or volutrauma: the dilemma. J Thorac Dis. 2018;10:1258–64.

    Article  Google Scholar 

  10. Thompson BT, Chambers RC, Liu KD. Acute respiratory distress syndrome. N Engl J Med. 2017;377:1904–5.

    Article  Google Scholar 

  11. Tomashefski JF Jr. Pulmonary pathology of acute respiratory distress syndrome. Clin Chest Med. 2000;21:435–66.

    Article  Google Scholar 

  12. Gattinoni L, Marini JJ, Pesenti A, Quintel M, Mancebo J, Brochard L. The “baby lung” became an adult. Intensive Care Med. 2016;42:663–73.

    Article  Google Scholar 

  13. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307:2526–33.

    PubMed  Google Scholar 

  14. Kao KC, Hu HC, Chang CH, et al. Diffuse alveolar damage associated mortality in selected acute respiratory distress syndrome patients with open lung biopsy. Crit Care. 2015;19:228.

    Article  Google Scholar 

  15. Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med. 1998;158:3–11.

    Article  CAS  Google Scholar 

  16. Caironi P, Carlesso E, Cressoni M, et al. Lung recruitability is better estimated according to the Berlin definition of acute respiratory distress syndrome at standard 5 cmH2O rather than higher positive end-expiratory pressure: a retrospective cohort study. Crit Care Med. 2015;43:781–90.

    Article  Google Scholar 

  17. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369:2126–36.

    Article  CAS  Google Scholar 

  18. Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis. 1988;137:1159–64.

    Article  CAS  Google Scholar 

  19. Grasso S, Terragni P, Birocco A, et al. ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure. Intensive Care Med. 2012;38:395–403.

    Article  CAS  Google Scholar 

  20. Mead J, Takishima T, Leith D. Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol. 1970;28:596–608.

    Article  CAS  Google Scholar 

  21. Gattinoni L, Taccone P, Carlesso E, Marini JJ. Prone position in acute respiratory distress syndrome. Rationale, indications, and limits. Am J Respir Crit Care Med. 2013;188:1286–93.

    Article  CAS  Google Scholar 

  22. Henderson AC, Sa RC, Theilmann RJ, Buxton RB, Prisk GK, Hopkins SR. The gravitational distribution of ventilation-perfusion ratio is more uniform in prone than supine posture in the normal human lung. J Appl Physiol (1985). 2013;115:313–24.

    Article  Google Scholar 

  23. Sud S, Friedrich JO, Taccone P, et al. Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med. 2010;36:585–99.

    Article  Google Scholar 

  24. Guerin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159–68.

    Article  CAS  Google Scholar 

  25. Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195:1253–63.

    Article  Google Scholar 

  26. Cressoni M, Chiumello D, Algieri I, et al. Opening pressures and atelectrauma in acute respiratory distress syndrome. Intensive Care Med. 2017;43:603–11.

    Article  Google Scholar 

  27. Ferguson ND, Cook DJ, Guyatt GH, et al. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med. 2013;368:795–805.

    Article  CAS  Google Scholar 

  28. Meade MO, Young D, Hanna S, et al. Severity of hypoxemia and effect of high-frequency oscillatory ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;196:727–33.

    Article  Google Scholar 

  29. Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378:1965–75.

    Article  Google Scholar 

  30. Vaquer S, de Haro C, Peruga P, Oliva JC, Artigas A. Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome. Ann Intensive Care. 2017;7:51.

    Article  Google Scholar 

  31. Albert SP, Dirocco J, Allen GB, et al. The role of time and pressure on alveolar recruitment. J Appl Physiol (1985). 2009;106:757–65.

    Article  Google Scholar 

  32. Hasan D, Satalin J, van der Zee P, et al. Excessive extracellular ATP desensitizes P2Y2 and P2X4 ATP receptors provoking surfactant impairment ending in ventilation-induced lung injury. Int J Mol Sci. 2018;19:1185.

    Google Scholar 

  33. Kollisch-Singule M, Emr B, Smith B, et al. Airway pressure release ventilation reduces conducting airway micro-strain in lung injury. J Am Coll Surg. 2014;219:968–76.

    Article  Google Scholar 

  34. Zhou Y, Jin X, Lv Y, et al. Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome. Intensive Care Med. 2017;43:1648–59.

    Article  Google Scholar 

Download references

Acknowledgment

We thank Nathalie Timmerman for her support in the preparation of figures.

Author information

Authors and Affiliations

  1. Department of Adult Intensive Care Medicine, Erasmus MC, Erasmus University Rotterdam, Rotterdam, The Netherlands

    P. van der Zee & D. Gommers

Authors
  1. P. van der Zee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Gommers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Gommers .

Editor information

Editors and Affiliations

  1. Dept. of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

van der Zee, P., Gommers, D. (2019). Recruitment Maneuvers and Higher PEEP, the So-Called Open Lung Concept, in Patients with ARDS. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2019. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-06067-1_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-06067-1_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-06066-4

  • Online ISBN: 978-3-030-06067-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation