Lung Volume Recruitment - Respiratory

Question 1

What are the 3 ARDS criteria for performing a recruitment maneuver?

Answer 1

Severe ARDS:
P/F ratio <100
Diffuse changes on CXR
Decreased lung compliance (eg. elevated plateau pressure)

Question 2

If a physician and/or an RT is present what are the three steps for a lung recruitment maneuver?

Answer 2

1. Admin a 20ml/kg Ringers bolus if hypotension from intravascular volume depletion present
2. Leave the pt on the hospital vent and request RT performs a 40/40 maneuver (40 cm H2O for 40 seconds per hosp. protocol)
3. Sedate the pt to a state of apnea (with addition of paralysis if needed)

Question 3

What are the 3 bailout conditions for a recruitment maneuver?

Answer 3

1. MAP decreases by 20% or SBP decreases to <80mmHg OR
2. Absolute drop in SpO2 >10 points from baseline OR
3. Appearance of cardiac dysrhythmias

Question 4

What are the 7 steps for a recruitment maneuver if there is no physician/RT present (updated from MDSO for Ti)?

Answer 4

1. Select APRV
2. Adjust P high to 30cmH2O
3. Adjust T high to 30 seconds
4. Adjust P low to +2 above your current PEEP
5. Disable “Apnea Backup” setting
6. Initiate recruitment ensuring Paw is 30 cmH2O (if <30 cmH2O press Manual Breath button)
7. Immediately change Mode to (S)CMV+ or PCV+ and confirm (new default mode post-recruitment)

Question 5

What are the ventilator settings post-recruitment maneuver as per the MDSO?

Answer 5

1. Pressure Control (PSIMV+/PCV+), target 4-6 ml/kg IBW
2. Increase PEEP by 2-4 cm H2O above pre-RM setting (monitor SpO2 for improvement, drop in Vt = overdistension from high PEEP)
3. If SpO2 decreases to <90% and hemodynamics stable, repeat RM and adjust PEEP by additional 2 cm H2O from #2 setting
4. Adjust PEEP and wean FiO2 per ARDSnet table to improve SpO2