LVRM CBO Flashcards
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What is the main purpose of a Lung Volume Recruitment Maneuver (LVRM)
- Improve gas exchange
- Attenuate ventilator-induced lung injury (VILI)
- Increase lung compliance
- Minimize Physiologic deadspace
How are Lung Volume Recruitment Maneuver (LVRM) performed/entail?
Applying sustained inflation or Intermittent signs
What are the aims and goals of sustained inflation?
Aims to cause incremental improvement in oxygenation if pressure are adequate.
- may achieve optimal ventilation lung volumes
Why is sustained inflation a preferred method of Lung Volume Recruitment Maneuver (LVRM)?
Minimical complications w/good success prognosis in infants.
- not a definitely superior technique
How is optimal PEEP determined?
By comparing the lower and upper (LIP and UIP) of the pressure volume (PV) curve.
- Aim for the best compliance with a driving pressure <15 and linearity of 3 among 3 levels.
What are indications for Lung Volume Recruitment Maneuvers (LVRM)?
- After disconnection from the ventilator
- After suctioning
- Evidence of atelectasis
- Low Sats
What are contraindications for Lung Volume Recruitment Maneuvers (LVRM)?
Chest tubes or air leak
- evidence of barotrauma, pneumothorax, subcutaneous emphysema, pulmonary intestinal emphysema (PIE)
How is sustained inflation performed?
Apply excess of expected alveolar opening pressures for periods of 5-30 secs
- aka apply CPAP for 30s
what CPAP levels should be applied during sustained inflation for differing patient weights?
- Less than 10 kg = 30 cmH2O
- 10 – 30 kg = 35 cmH2O
- > 30 kg = 40 cmH2O
What is the procedure for Intermittent sighs?
Supplementing several breaths
- PEEP 2-5 cmH2O higher
- PIP around 30 cmH2O (weight dependant)
What level of CPAP should be used for Intermittent Sighs?
- Less than 10 kg = 30 cmH2O
- 10 – 30 kg = 35 cmH2O
- > 30 kg = 40 cmH2O
When should you discontinue a patients Lung Volume Recruitment Maneuver (LVRM)?
If the patient desaturates or HR changes by 20%
- HR less than 60 or greater than 140
- MAP less than 60 or 20% from baseline
- New arrhythmia
- Desats to less than 80%
What should you monitor for a Lung Volume Recruitment Maneuver (LVRM)?
SpO2, EtCO2, and HR.
- May be useful to do low flow inflection point analysis
What’s the difference between a TLC breath and LVRM?
TLC breaths prevent atelectasis and help recruit/maintain alveolar expansion.
- TLC breaths are quick large controlled breaths that are synced with the patients effort.
- LVRMs are sustained breaths at higher pressures
How are TLC breaths delivered?
Quick breaths that are synced to the patients effort.
- 10 breaths
How are LVRM breaths on the bagger performed?
Sets of 3x(3-5) sets of sustained breath stacks
Absolute contraindications for LVRMs (5)
- Chest tube w/current or previous leak
- Barotrauma evidence by pneumothorax, SubQ, PIE, etc. etc. air leaks
- Resp failure due to obstructive pulmonary diseases
- Post op thoracic surgical pts
- MAP less than 60
How do you initiate LVRMs on PS/CPAP?
- Ensure appropriate alarm settings + backup (if present) is off
- PEEP to 40
- PS above PEEP 0
- count for 40 (or 30)
- Switch to prior mode, readjust alarm settings/backup
How do you P/V tool to perform LVRMs? (only on the c6)
- Tools -> P/V tool
- P start = 0
- P top = 40
- End Peep = 0
- Ramp speed = -2
- T pause = 0 sec
On a manual LVRM, how long should the patient hold their breath after stacking breaths?
3-5 seconds
