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Complications of Hypovolemic and Septic Shock
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Meghann L. Kaiser, Matthew O. Dolich
Other treatment strategies for ARDS and ALI include the popular “open lung” ventilation techniques, but they lack such a clear-cut survival benefit. Open lung ventilation is defined by a positive end-expiratory pressure (PEEP) set above the initial opening alveolar pressure, as determined by the lower inflection point on the sigmoidal pressure–volume curve (Figure 11.1). Recruitment maneuvers (a few moments of sustained high inspiratory pressure at the initiation of mechanical ventilation) are commonly used to open collapsed alveoli, followed by PEEP to maintain their patency and capacity for gas exchange. PEEP improves oxygenation, but studies seeking to demonstrate a mortality benefit have yielded conflicting data. In patients with ALI, as opposed to ARDS, higher levels of PEEP may actually be harmful. PEEP and recruitment maneuvers can produce deleterious hemodynamic effects that may account for some mixed success in ARDS, especially in the setting of hypovolemic or septic shock. Airway pressure release ventilation (APRV) is a ventilatory mode that supports spontaneous ventilation at consistent moderately elevated airway pressures (around 25 mm Hg), with the hope of re-establishing normal chest wall compliance and avoiding shear forces related to pressure changes. High-frequency oscillatory ventilation (HFOV) uses a piston-driven ventilator to administer relatively tiny tidal volumes well below the dead-space volume. This creates continuous convection and other complex patterns of air flow, while maintaining mean airway pressure. HFOV is currently under investigation in the randomized multicenter OSCILLATE and OSCAR trials.
Effect of Stepwise Lung Recruitment Maneuver on Oxygenation, Lung Mechanics and Lung Injury Biomarkers During Lung Resection Surgery: A Prospective Randomized Controlled Single Blinded Study
Published in Egyptian Journal of Anaesthesia, 2022
Dalia Ahmed El Sayed El Hefny, Mohamed Ibrahim Mohamed, Shahira Ahmed Yousef El-Metainy, Mohamed Moustafa Ibrahim Abdelaal, Yasser Mohamed Osman
In agreement with our results, Rauseo et al. [12] found that the application of an open lung ventilation strategy consisting of cycling recruitment followed by a decremental PEEP titration during OLV significantly improved lung compliance and compliance of the respiratory system. Also Ferrando et al. [7] found that recruitment applied during one lung ventilation had increased the static compliance significantly suggesting a constant end-expiratory lung volume. Moreover, Miura et al. [13] found that respiratory compliance was significantly increased after recruitment during OLV.