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Recruitment Maneuvers and PEEP Titration.

Dean R Hess1

  • 1Massachusetts General Hospital, Harvard Medical School, and Northeastern University, Boston, Massachusetts. dhess@mgh.harvard.edu.

Respiratory Care
|October 24, 2015
PubMed
Summary

Lung protective mechanical ventilation is crucial. Selecting positive end-expiratory pressure (PEEP) involves balancing alveolar recruitment and overdistention, with suggested levels based on ARDS severity to optimize lung protection.

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Area of Science:

  • Critical Care Medicine
  • Pulmonary Physiology
  • Mechanical Ventilation

Background:

  • Alveolar overdistention during mechanical ventilation causes harm.
  • Pressure and volume limitation are vital in ventilation.
  • The utility of alveolar recruitment maneuvers remains debated.

Purpose of the Study:

  • To evaluate the role and optimal application of recruitment maneuvers and PEEP titration in ARDS.
  • To determine strategies for selecting appropriate PEEP levels.
  • To emphasize lung protection over solely improving oxygenation.

Main Methods:

  • Discusses stepwise recruitment maneuvers versus sustained inflation.
  • Reviews various PEEP titration approaches.
  • Proposes PEEP selection based on ARDS severity (mild, moderate, severe).

Main Results:

  • Alveolar recruitment potential varies significantly among ARDS patients.
  • Stepwise recruitment maneuvers are preferred over sustained inflation.
  • A simplified PEEP selection strategy based on ARDS severity is suggested.

Conclusions:

  • PEEP selection should balance alveolar recruitment and overdistention risks.
  • Suggested PEEP ranges: mild ARDS (5-10 cm H2O), moderate ARDS (10-15 cm H2O), severe ARDS (15-20 cm H2O).
  • Recruitment maneuvers and PEEP should be integrated into a lung protection strategy.
Keywords:
ARDSPEEPmechanical ventilationrecruitment maneuver

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