Lung Recruitment Maneuver

Question 1

Lung Volume Recruitment Manoeuvre

Answer 1

The main goal of LVRM is to open up as many alveolar units as possible using a high inspiratory pressure

And then set an appropriate PEEP level

There are different method for lung recruitment manouvers

High sustainable PEEP (CPAP) of 30-40 cmh2O for 30-60 seconds

It is extremely important to monitor vitals during this

Question 2

What is the main indicator for LVRM

Answer 2

The main indicator is a CXR showing diffuse bilateral infiltrates (ALI/ARDS)

Question 3

ALI Criteria

Answer 3

diffuse bilat infiltrates on CXR, PAWP <18, PF < 300

Question 4

ARDS Criteria

Answer 4

diffuse bilat infiltrates on CXR

PAWP <18

PF < 200

Question 5

Other LVRM Indicators

Answer 5

Atelectasis

Increased OI (eg. > 12; may vary with institution)

Patients requiring a high PEEP

May also be done in patients who de-sat after disconnect/suctioning

Question 6

MURRAY LUNG SCORE

Answer 6

Patients with ARDS and a Murray Score of 3-4 may be considered for ECMO cannulation in the correct clinical setting.

Patients with a Murray Score >2 could be considered for transfer to a center with ECMO capabilities.

Question 7

Contraindications

Answer 7

• Pulmonary air leaks:
  
  • Recent, active pneumothorax, PIE, etc
  • Bronchopleural fistula
• Hemodynamic instability (eg. low BP)
• Head Injury
• Obstructive lung disease
• Pregnancy

Question 8

Lung Volume Recruitment Manoeuvre Cautions

Answer 8

Watch vital signs during maneuver (hypotension a common side effect)

Watch for hypoxemia

Question 9

Lung Volume Recruitment Manoeuvre When to Discontinue

Answer 9

If SpO2 falls < 80%

MAP < 60 or 20% change from baseline

HR < 60 or 20% change from BL

New arrhythmia