Recruitment Maneuvers and Higher PEEP, the So-Called Open Lung Concept, in Patients with ARDS

Abstract

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2019. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2019 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901 .

Fig. 1

Lung recruitment as a function of airway pressure. This figure represents the amount of lung tissue (grams) recruited as a function of applied airway pressure. Estimates were based on computed tomography (CT) images of patients with acute respiratory distress syndrome (ARDS). Green: mild ARDS, blue: moderate ARDS, red: severe ARDS, dark red: severe ARDS with venovenous extracorporeal membrand oxygenation (VV-ECMO). From [26] with permission

Fig. 2

Indication for the open lung concept (OLC) in acute respiratory distress syndrome (ARDS). This figure represents the indication for ARDSNet protocol, OLC and venovenous extracorporeal membrane oxygenation (VV-ECMO) according to the PaO₂/FiO₂ ratio

Fig. 3

Responders and non-responders to the open lung concept (OLC). Lung aeration at expiration is schematically depicted in the ARDSNet protocol (left) and in responders (middle) and non-responders (right) to the OLC, i.e., a recruitment maneuver and higher positive end-expiratory pressure (PEEP) levels. In responders, functional residual capacity increases in response to recruitment, resulting in reduced strain and driving pressure. In non-responders, functional residual capacity does not increase following a recruitment maneuver. Subsequent application of higher PEEP levels results in alveolar overdistention. Very light blue: overdistention; light blue: normally aerated lung tissue; dark blue: collapsed alveoli