OVERVIEW

• [ ] Recruitment manoeuvres are transient increases in transpulmonary pressure designed to open up collapsed airless alveoli
• [ ] Primarily used in severe acute respiratory distress syndrome (ARDS)
• [ ] They can be used as part of an open lung approach to mechanical ventilation
• [ ] Their role, and how they should be performed, remains controversial

RATIONALE

De-recruitment can occur due to:

• [ ] low tidal volume (TV) ventilation
• [ ] inadequate postive end-expiratory pressure (PEEP)
• [ ] or use of high FiO2 (absorption atelectasis)

During tidal ventilation 3 distinct lung zones are produced, associated with different types of ventilator-induced lung injury (VILI):

• [ ] dependent: collapsed throughout tidal ventilation despite high levels of PEEP, causes chronic collapse injury
• [ ] intermediate: cyclic collapse and re-expansion with each breath, causes shear induced injury (atelectrauma)
• [ ] least dependent: regions that remain inflated through out tidal ventilation and can be over inflated by TV of > 6mL/kg and plateau pressures exceeding > 30-35cmH2O, causes volutrauma and barotrauma
• [ ] all of these mechanisms can increase cytokine release (biotrauma) and contribute to risk of multi-organ failure and mortality

Recruitment manoeuvres are used to open up collapsed lung, and PEEP is used to prevent cyclic collapse as part of an open lung approach to ventilation to:

• [ ] increase end-expiratory lung volume
• [ ] improve gas exchange
• [ ] decrease VILI

METHODS