RT Journal Article
SR Electronic
T1 Recruitment Maneuvers and PEEP Titration
JF Respiratory Care
FD American Association for Respiratory Care
SP 1688
OP 1704
DO 10.4187/respcare.04409
VO 60
IS 11
A1 Dean R Hess
YR 2015
UL http://rc.rcjournal.com/content/60/11/1688.abstract
AB The injurious effects of alveolar overdistention are well accepted, and there is little debate regarding the importance of pressure and volume limitation during mechanical ventilation. The role of recruitment maneuvers is more controversial. Alveolar recruitment is desirable if it can be achieved, but the potential for recruitment is variable among patients with ARDS. A stepwise recruitment maneuver, similar to an incremental PEEP titration, is favored over sustained inflation recruitment maneuvers. Many approaches to PEEP titration have been proposed, and the best method to choose the most appropriate level for an individual patient is unclear. A PEEP level should be selected that balances alveolar recruitment against overdistention. The easiest approach to select PEEP might be according to the severity of the disease: 5–10 cm H2O PEEP in mild ARDS, 10–15 cm H2O PEEP in moderate ARDS, and 15–20 cm H2O PEEP in severe ARDS. Recruitment maneuvers and PEEP should be used within the context of lung protection and not just as a means of improving oxygenation.