Document Detail


Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?
MedLine Citation:
PMID:  16029227     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A literature review was conducted to assess the evidence for recruitment manoeuvres used in conventional mechanical positive pressure ventilation. A total of 61 studies on recruitment manoeuvres were identified: 13 experimental, 31 ICU, 6 PICU and 12 anaesthesia studies. Recruitment appears to be a continuous process during inspiration and expiration and is determined by peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP). Single or repeated recruitment manoeuvres may result in a statistically significant increase in oxygenation; however, this is short lasting and clinically irrelevant, especially in late ARDS and pneumonia. Temporary PIP elevation may be effective but only after PEEP loss (for example disconnection and tracheal suctioning). Continuous PEEP elevation and prone positioning can increase P(a)O2 significantly. Adverse haemodynamic or barotrauma effects are reported in various studies. No data exist on the effect of recruitment manoeuvres on mortality, morbidity, length of stay or duration of mechanical ventilation. Although recruitment manoeuvres can improve oxygenation, they can potentially increase lung injury, which eventually determines outcome. Based on the presently available literature, prone position and sufficient PEEP as part of a lung protective ventilation strategy seem to be the safest and most effective recruitment manoeuvres. As paediatric physiology is essentially different from adult, paediatric studies are needed to determine the role of recruitment manoeuvres in the PICU.
Authors:
F J J Halbertsma; J G van der Hoeven
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Anaesthesia     Volume:  60     ISSN:  0003-2409     ISO Abbreviation:  Anaesthesia     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-07-20     Completed Date:  2005-08-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370524     Medline TA:  Anaesthesia     Country:  England    
Other Details:
Languages:  eng     Pagination:  779-90     Citation Subset:  AIM; IM    
Affiliation:
Department of Paediatric Intensive Care, University Medical Centre Nijmegen St. Radboud, PB 9101, 6500 HB Nijmegen, the Netherlands. F.Halbertsma@ic.umcn.nl
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MeSH Terms
Descriptor/Qualifier:
Anesthesia
Animals
Child
Humans
Intensive Care / methods
Intensive Care Units, Pediatric*
Oxygen / blood
Partial Pressure
Positive-Pressure Respiration / methods*
Pulmonary Alveoli / physiopathology
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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