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Lung recruitment-A guide for clinicians
Journal article   Peer reviewed

Lung recruitment-A guide for clinicians

J I Jauncey-Cooke, Fiona E Bogossian and C E East
Australian Critical Care, Vol.22(4), pp.155-162
2009
DOI: https://doi.org/10.1016/j.aucc.2009.06.004
url
https://doi.org/10.1016/j.aucc.2009.06.004View
Published Version

Abstract

mechanical ventilation recruitment positive end expiratory pressure sustained inflation paediatric lung protective ventilation
Recruitment manoeuvres play an important role in minimising ventilator associated lung injury (VALI) particularly when lung protective ventilation strategies are employed and as such clinicians should consider their application. This paper provides evidence-based recommendations for clinical practice with regard to alveolar recruitment. It includes recommendations for timing of recruitment, strategies of recruitment and methods of measuring the efficacy of recruitment manoeuvres and contributes to knowledge about the risks associated with recruitment manoeuvres. There are a range of methods for recruiting alveoli, most notably by manipulating positive end expiratory pressure (PEEP) and peak inspiratory pressure (PIP) with consensus as to the most effective not yet determined. A number of studies have demonstrated that improvement in oxygenation is rarely sustained following a recruitment manoeuvre and it is questionable whether improved oxygenation should be the clinician's goal. Transient haemodynamic compromise has been noted in a number of studies with a few studies reporting persistent, harmful sequelae to recruitment manoeuvres. No studies have been located that assess the impact of recruitment manoeuvres on length of ventilation, length of stay, morbidity or mortality. Recruitment manoeuvres restore end expiratory lung volume by overcoming threshold opening pressures and are most effective when applied after circuit disconnection and airway suction. Whether this ultimately improves outcomes in adult or paediatric populations is unknown. © 2009 Australian College of Critical Care Nurses Ltd.

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