New and conventional strategies for lung recruitment in acute respiratory distress syndrome

Abstract

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855.

Figure 1

Computed tomography images of oleic acid-induced acute lung injury in dogs at different inspiratory and expiratory pressures. Note the improvement in alveolar aeration at end-expiration after the recruitment maneuver. Large arrows represent inspiration and expiration. Double-ended arrows represent the tidal breathing (end-expiration and end-inspiration). Adapted from [4].

Figure 2

Percentage of change in static lung elastance (Est, L), oxygenation (PaO₂), fractional area of alveolar collapse (Coll) and hyperinflation (Hyp), and mRNA expression of type III procollagen (PCIII) from sustained inflation (SI) and sigh at different frequencies (10, 15 and 180 per hour) to non-recruited acute lung injury rats. Note that at low sigh frequency, oxygenation and lung elastance improved, followed by a reduction in alveolar collapse and PCIII. Adapted from [38].

Figure 3

Pulmonary perfusion maps of the left lung in one animal with acute lung injury induced by lavage. Left panel: Perfusion map after induction of injury and mechanical ventilation according to the ARDS Network protocol. Right panel: Perfusion map after 6 h of mechanical ventilation according to the ARDS Network protocol, but using variable tidal volumes. Note the increase in perfusion in the more dependent basal-dorsal zones (ellipses), suggesting alveolar recruitment through variable ventilation. Blue voxels represents lowest and red voxels, highest relative pulmonary blood flow. Adapted from [41].