Recruitment maneuvers and positive end-expiratory pressure/tidal ventilation titration in acute lung injury/acute respiratory distress syndrome: translating experimental results to clinical practice

Abstract

Recruitment maneuvers and positive end-expiratory pressure (PEEP)/tidal ventilation titration in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) are the cornerstone of mechanical ventilatory support. The net result of these possible adjustments in ventilatory parameters is the interaction of the pressure applied in the respiratory system (airway pressure/end expiratory pressure) counterbalanced by chest wall configuration/abdominal pressure along the mechanical ventilatory support duration. Refinements in the ventilatory adjustments in ALI/ARDS are necessary for minimizing the biotrauma in this still life-threatening clinical problem.

Figure 1

Thoracic tomography of two different models of acute lung injury/acute respiratory distress syndrome (ARDS). (a) Computed tomography (CT) scan of pigs after saline lung lavage before and after recruitment maneuvers with 45 cmH₂O of pressure, maintaining a positive end-expiratory pressure (PEEP) of 10 cmH₂O, showing some redistribution of ventilation [1]. (b) CT scan of acute respiratory distress syndrome patients before and after a recruitment maneuver with 60 cmH₂O maximal inspiratory pressure maintaining PEEP values of 20 and 25 cmH₂O.