Abstract
Ventilatory strategies preventing alveolar overdistension and cyclic end-expiratory collapse are now well accepted. Nevertheless, ventilation with low tidal volume may be associated with lung atelectasis and oxygenation impairment. Atelectasis may be due to compression phenomenon or to progressive alveolar gas absorption. To achieve optimal lung recruitment and to prevent collapse of lung units, several “mneuvers” are now proposed (prone position, sighs, sustained inflations). In this chapter, we will summarize some aspects regarding alveolar recruitment and stabilization during mechanical ventilation of patients with acute respiratory distress syndrome (ARDS).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Pelosi P, D’Andrea L, Vitale G, Pesenti A, Gattinoni L (1994) Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care Med 149:8–13
Malbouisson L, Busch CJ, Puybasset L, Lu Q, Cluzel P, Rouby JJ and the CT Scan ARDS Study group (2000) Role of the heart in the loss of aeration characterizing lower lobes in acute respiratory distress syndrome. Am J Respir Crit Care Med 161:2005–2012
Puybasset L, Cluzel P, Chao N, Slutsky AS, Coriat P, Rouby JJ and the CT Scan ARDS Study Group (1998) A computed tomography scan assessment of regional lung volume in acute lung injury. Am J Respir Crit Care Med 158:1644–1655
Puybasset L, Cluzel P, Gusman P, Grenier P, Preteux F, Rouby JJ and the CT Scan ARDS Study group (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. Intensive Care Med 26:857–869
Kunst PW, Böhm SH, Vasquez de Anda G, et al (2000) Regional pressure volume curves by electrical impedance tomography in a model a acute lung injury. Crit Care Med 28:178–183
Gattinoni L, Pelosi P, Crotti S, Valenza F (1995) Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med 151:1807–1814
Van der Kloot TE, Blanch L, Youngblood AM, et al (2000) Recruitment maneuvers in three experimental models of acute lung injury. Effect on lung volume and gas exchange. Am J Respir Crit Care Med 161:1485–1494
Rimensberger PC, Pristine G, Mullen JB, Cox PN, Slutsky AS (1999) Lung recruitment during small tidal volume ventilation allows minimal positive end-expiratory pressure without augmenting lung injury. Crit Care Med 27:1940–1945
Amato MB, Barbas CS, Medeiros DM, et al (1995) Beneficial effects of the “open lung approach” with low distending pressures in acute respiratory distress syndrome. A prospective randomized study on mechanical ventilation. Am J Respir Crit Care Med 152:1835–1846
Amato MBP, Barbas CSV, Medeiros DM, et al (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354
Stewart TE, Meade MO, Cook DJ, et al (1998) Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. N Engl J Med 338: 355–361
Brochard L, Roudot-Thoraval F, Roupie E, et al (1998) Tidal volume reduction in acute respiratory distress syndrome (ARDS): a multicenter randomized study. Am J Respir Crit Care Med 158:1831–1838
The acute respiratory distress syndrome network (2000) Ventilation with low tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308
Artiga A, Bernard GR, Carlet J, et al (1998) The American-European Consensus Conference on ARDS, Part 2. Am J Respir Crit Care Med 157:1332–1337
Pelosi P, Cadringher P, Bottino N, et al (1999) Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med 159:872–880
Santos C, Ferrer M, Roca J, et al (2000) Pulmonary gas exchange response to oxygen breathing in acute lung injury. Am J Respir Crit Care Med 161:26–31
Böhm SH, Vasquez de Anda GF, Lachmann B (1998) The open lung concept. In: Vincent JL (ed) Yearbook of Intensive Care and Emergency Medicine. Springer, Berhn, pp 430–440
Lachmann B (1992) Open up the lung and keep the lung open. Intensive Care Med 18:319–321
Svantesson C, Sigurdsson S, Larsson A, Jonson B (1998) Effects of recruitment of collapsed lung units on the elastic pressure-volume relationship in anaesthetised healthy adults. Acta Anaesthesiol Scand 42:1149–1156
Jonson B, Richard JC, Strauss C, Mancebo J, Lemaire F, Brochard L (1999) Pressure-Volume curves and compliance in acute lung injury. Evidence of recruitment above the lower inflection point. Am J Respir Crit Care Med 159:1172–1178
Ghelucci GL, Dall’Ava-Santucci J, Dhainaut JF, et al (2000) Association of PEEP with two different inflation volumes in ARDS patients: effects on passive lung deflation and alveolar recruitment. Intensive Care Med 26:870–877
Hartog A, Vasquez de Anda GF, Gommers D, Kaisers U, Lachmann B (2000) At surfactant deficiency, application of “the open lung concept” prevents protein leakage and attenuates changes in lung mechanics. Crit Care Med 28:1450–1454
Rimensberger PC, Cox PN, Frndova H, Bryan AC (1999) The open lung during small tidal volume ventilation: concepts of recruitment and “optimal” positive end-expiratory pressure. Crit Care Med 27:1946–1952
Rimensberger PC, Pache JC, McKerlie C, Frndova H, Cox PN (2000) Lung recruitment and lung volume maintenance: a strategy for improving oxygenation and preventing lung injury during both conventional mechanical ventilation and high-frequency oscillation. Intensive Care Med 26:745–755
Guérin C, Badet M, Rosselli S, et al (1999) Effects of prone position on alveolar recruitment and oxygenation in acute injury. Intensive Care Med 25:1222–1230
Cakar N, Van der Kloot T, Youngblood M, Adams A, Nahum A. (2000) Oxygenation response to a recruitment maneuver during supine and prone positions in an oleic acid-induced lung injury model Am J Respir Crit Care Med 161:1949–1956
Broccard A, Shapiro S, Schmitz L, et al (2000) Prone positioning attenuates and redistributes ventilator-induced lung injury in dogs. Crit Care Med 28:295–303
Nakos G, Tsangaris I, Kostanti E, et al (2000) Effect of the prone position on patients with hydrostatic pulmonary edema compared with patients with acute respiratory distress syndrome and pulmonary fibrosis. Am J Respir Crit Care Med 161:360–368
Albert RK, Hubmayr RF (2000) The prone position eliminates compression of the lungs by the heart. Am J Respir Crit Care Med 161:1660–1665
Jolliet P, Bulpa P, Chevrolet JC (1998) Effects of the prone position on gas exchange and hemodynamics in severe acute respiratory distress syndrome. Crit Care Med 26:1977–1985
Curley MAQ, Thompson JE, Arnold JH (2000) The effects of early and repeated prone positioning in pediatric patients with acute lung injury. Chest 118:156–163
Borelli M, Lampatti L, Vascotto E, Fumagalli R, Pesenti A (2000) Hemodynamic and gas exchange response to inhaled nitric oxide and prone positioning in acute respiratory distress syndrome patients. Crit Care Med 28:2707–2712
Pelosi P, Tubiolo D, Mascheroni D, et al (1998) Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury. Am J Respir Crit Care Med 157:387–393
Pelosi P, Cadringher P, Bottino N, et al (1999) Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med 159:872–880
Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 158:3–11
Muscedere JG, Mullen JBM, Gan K (1994) Tidal ventilation at low airway pressure can augment lung injury. Am J Respir Crit Care Med 149:1327–1334
Ruiz-Bailen M, Fernandez-Mondejar E, Hurtado-Ruiz B, et al (1999) Immediate application of positive-end expiratory pressure is more effective than delayed positive-end expiratory pressure to reduce extravascular lung water. Crit Care Med 27:380–384
Medoff BD, Harris RS, Kesselman H, Venegas J, Amato MBP, Hess D (2000) Use of recruitment maneuvers and high positive end-expiratory pressure in a patient with acute respiratory distress syndrome. Crit Care Med 28:1210–1216
Foti G, Cereda M, Sparacino ME, De Marchi I, Villa F, Pesenti A (2000) Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients. Intensive Care Med 26:501–507
Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G (1993) Reexpansion of atelectasis during general anaesthesia: a computed tomography study Br J Anaesth 71:788–795
Lapinsky SE, Aubin M, Mehta S, Boiteau P, Slutsky A (1999) Safety and efficacy of a sustained inflation for alveolar recruitment in adults with respiratory failure. Intensive Care Med 25: 1297–1301
Putensen C, Rasanen J, Lopez FA (1994) Ventilation-perfusion distributions during mechanical ventilation with surimposed spontaneous breathing in canine lung injury. Am J Respir Crit Care Med 150:101–108
Putensen C, Mutz NJ, Putensen-Himmer G, Zinserling J (1999) Spontaneous breathing during ventilatory support improves ventilation-perfusion distributions in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 159:1241–1248
Rouby JJ, Puybasset L, Cluzel P, et al (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. IL Physiological correlation and definition of an ARDS severity score. Intensive Care Med 26:1046–1056
Mink SN, Light RB, Wood LD (1981) Effect of pneumococcal lobar pneumonia on canine lung mechanics. J Appl Physiol 50:283–291
Puybasset L, Gusman P, Muller JC, Cluzel P, Coriat P, Rouby JJ and the CT Scan ARDS Study Group (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. III. Consequences for the effects of positive end-expiratory pressure. Intensive Care Med 26:1215–1227
Vieira SRR, Puybasset L, Richecoeur J, et al (1998) A lung computed tomographic assessment of positive end-expiratory pressure-induced lung overdistension. Am J Respir Crit Care Med 158: 1571–1577
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2001 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Sottiaux, T. (2001). Lung Recruitment and Stabilization in ARDS. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 2001. Yearbook of Intensive Care and Emergency Medicine 2001, vol 2001. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59467-0_36
Download citation
DOI: https://doi.org/10.1007/978-3-642-59467-0_36
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-41407-0
Online ISBN: 978-3-642-59467-0
eBook Packages: Springer Book Archive