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Clinical review : The implications of experimental and clinical studies of recruitment maneuvers in acute lung injury
Piacentini Gómez, Enrique (Institut Universitari Parc Taulí)
Villagrá, Ana (Institut Universitari Parc Taulí)
López Aguilar, Josefina (Institut Universitari Parc Taulí)
Blanch Torra, Lluís (Institut Universitari Parc Taulí)

Data: 2003
Resum: Mechanical ventilation can cause and perpetuate lung injury if alveolar overdistension, cyclic collapse, and reopening of alveolar units occur. The use of low tidal volume and limited airway pressure has improved survival in patients with acute lung injury or acute respiratory distress syndrome. The use of recruitment maneuvers has been proposed as an adjunct to mechanical ventilation to re-expand collapsed lung tissue. Many investigators have studied the benefits of recruitment maneuvers in healthy anesthetized patients and in patients ventilated with low positive end-expiratory pressure. However, it is unclear whether recruitment maneuvers are useful when patients with acute lung injury or acute respiratory distress syndrome are ventilated with high positive end-expiratory pressure, and in the presence of lung fibrosis or a stiff chest wall. Moreover, it is unclear whether the use of high airway pressures during recruitment maneuvers can cause bacterial translocation. This article reviews the intrinsic mechanisms of mechanical stress, the controversy regarding clinical use of recruitment maneuvers, and the interactions between lung infection and application of high intrathoracic pressures.
Drets: Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original. Creative Commons
Llengua: Anglès
Document: article ; recerca ; publishedVersion
Matèria: Acute lung injury ; Lung collapse ; Lung infection ; Mechanical stress ; Mechanical ventilation
Publicat a: Critical care, Vol. 8, N. 2 (September 2003) , p. 115-121, ISSN 1364-8535

DOI: 10.1186/cc2364
PMID: 15025772

7 p, 251.5 KB

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