Related Experiment Video
Updated: May 24, 2025
Ex Vivo Porcine Experimental Model for Studying and Teaching Lung Mechanics
Published on: April 19, 2024
Lung recruitment manoeuvre strategies in paediatric intensive care units across Europe
Elisa Poletto1, Marco Daverio2, Robert George Theodoor Blokpoel3
1Paediatric Intensive Care Unit, San Bortolo Hospital, Vicenza, Italy.
Insights
Lung recruitment manoeuvres (LRMs) are used in most European paediatric intensive care units (PICUs) for severe paediatric acute respiratory distress syndrome (PARDS), but practice varies widely. Further research is needed to establish standardized LRM protocols and improve patient outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Clinical Practice Surveys
Background:
- Severe paediatric acute respiratory distress syndrome (PARDS) presents significant management challenges.
- Lung recruitment manoeuvres (LRMs) are utilized to improve oxygenation in PARDS, but their application remains controversial.
- Current European practice regarding LRMs in paediatric intensive care units (PICUs) is not well-defined.
Purpose of the Study:
- To survey the current application of lung recruitment manoeuvres (LRMs) in European paediatric intensive care units (PICUs).
- To understand the variations in LRM practices, protocols, and perceived obstacles across different European PICUs.
Main Methods:
- An online survey was distributed to 276 PICUs across 19 European countries.
- The survey targeted paediatric intensivists, nurses, and respiratory therapists, allowing one response per unit.
- Data collected included LRM utilization, protocols, contraindications, methods, success metrics, complications, and barriers.
Main Results:
- 151 PICUs (54.8%) responded, with a majority being high-volume and ECMO centers.
- LRMs are employed in 78.9% of responding PICUs, but only 21.9% have a standardized protocol.
- Staircase recruitment manoeuvres (SRMs) are most common (69.5%); profound hypotension is the main reported complication (49.5%), and lack of familiarity is a key barrier (67.9%).
Conclusions:
- This survey offers the first overview of current LRM practices in European PICUs, revealing diverse application strategies.
- Significant variation exists in LRM protocols and implementation across European PICUs.
- Further research is essential to develop evidence-based guidelines for standardized LRM application in PARDS.
Introduction:
In severe paediatric acute respiratory distress syndrome (PARDS) lung recruitment manoeuvres (LRMs) may be applied to improve oxygenation, but their application is still controversial. The aim of this survey is to report what the current practice is across European paediatric intensive care units (PICUs).
Methods:
An online survey was distributed to PICUs in 19 European countries targeting paediatric intensivists, nurses and respiratory therapists. One reply per unit was allowed.
Results:
151 PICUs out of 276 (54.8%) responded. Of those, 75.9% have more than 300 admissions per year and 45.1% are extracorporeal membrane oxygenation (ECMO) centres. LRMs are employed in 78.9% of surveyed PICUs. Twenty-three out of 105 (21.9%) PICUs have a standardised protocol. LRMs are mainly performed by physicians (99%), supported by nurses (38.4%) and/or respiratory therapists (11.5%). The main reported contraindications are air leak (86.7%), haemodynamic instability (75.2%) and intracranial hypertension (63.8%). Staircase recruitment manoeuvres (SRMs) are the most commonly (69.5%) practiced LRMs, while sustained inflation is used in 44.8% of PICUs, alone or in addition to SRMs. The success of LRMs is measured through oxygenation improvement (oxygenation index or arterial oxygen tension/inspiratory oxygen fraction). Profound hypotension is the most reported complication (49.5%), while 35.2% did not report any complication. Lack of familiarity is the main obstacle to the application of LRMs (67.9%).
Conclusions:
To our best knowledge this is the first survey providing an overview of current LRMs application among European PICUs. Practise is diverse among countries and PICUs. Further research is necessary to build stronger evidence to support a more standard application of LRMs.
More Related Videos
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
04:56Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA
Published on: July 14, 2023
Related Concept Videos
01:14Ventilatory Modes
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:29Mechanical Ventilation I: Indication and Settings
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...