Respiratory Therapist and Medical Simulation Specialist | Educate clinicians how to deal with mechanical ventilators and give them solutions for medical training.
Lung recruitability assessment is so critical. Depending on CT scan guidance, there're many ARDS-related factors we should think about when it comes to the context of lung recruitabilty Is it - Focal or nonfocal? - Moderate or Severe? - Early or late? - Pulmonary or nonpulmonary? As many studies showed that nonpulmonary, nonfocal, severe, early stage ARDS most probably recruitment maneuver would be beneficial for them.
Hay Baggen
9mo
Additionaly, APRV is less likely to produce over-inflation or high-volume lung injury, as airway pressures are lowered (released) to accomplish ventilation.
PV Tool 😅✌🏻
Hay Baggen
9mo
Very nice post, Mahmoud! 👍
Hay Baggen
9mo
Mahmoud Osama APRV may offer potential clinical advantages for ventialtor management of ARDS and may be considered as an alternative "open lung approach" to mechanical ventilation. Whether APRV reduces mortality or increases ventilator -free days compared with conventional lung protective strategy will require future randomized controlled trials.
Hay Baggen
9mo
Mahmoud Osama The progress of mechanical power in the intensive care unit has to be our next attention!!
👍 Agreed; the severity and the progression are the recruit ability main elements.
Hay Baggen
9mo
Mahmoud Osama APRV with maintaining constant airway pressue may be advantageous for several reasons. Constant airway pressure facilitates alveolar recruitment, enhances diffusion of gases, allows alveolar units with slow time constants to fill, preventing over-distention of alveoli and augments collateral ventilation!
Ventilation specialist at Maastricht University Medical Center (n.p.). Instructor regarding taking special care of an acute and vital threatening child and adult. Instructor airwaymanagement and mechanical ventilation.
9moMahmoud Osama Yes, the lung recruitability is so crucial and thank you very much for sharing this picture. I would like to add the following: A lung recruitment maneuver comprises the application of high airway pressures and/or PEEP for a variable duration of time to open collapsed lung units. A recruitment maneuver is usually followed by a trial of PEEP decrements to adjudicate the minimum PEEP required to keep the lung open. Multiple trials have failed to demonstrate benefit of using recruitment maneuvers in ARDS patients. The most recent RCT of recruitment maneuvers in ARDS was the multicenter Alveolar Recruitment for ARDS Trial (ART). This study randomized patients with moderate or severe ARDS to one of two strategies: one with a lung recruitment maneuver and PEEP titration determined by the best respiratory system compliance or one with a control approach of low PEEP. There was a significant increase in 28-day and 6-month mortality in the recruitment maneuver arm.