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LUNG RECRUITMENT

Atelectasis. LUNG RECRUITMENT. Recruitment, PEEP titration and Open Lung Tool®. Stepwise alternating PC level procedure. Open Lung Tool. Preparations Pressure Control Ventilation 6 ml/kg PBW (Predicted Body Weight) I:E Ratio 1 to 1 Set Upper Pressure Limit Alarm Stabile Hemodynamics

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LUNG RECRUITMENT

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  1. Atelectasis LUNG RECRUITMENT Recruitment, PEEP titration and Open Lung Tool®

  2. Stepwise alternating PC level procedure EDU-08-0007, ver 00

  3. Open Lung Tool Preparations • Pressure Control Ventilation • 6 ml/kg PBW (Predicted Body Weight) • I:E Ratio 1 to 1 • Set Upper Pressure Limit Alarm • Stabile Hemodynamics • Sedation • Relaxation? • Have a maximum pressure target before starting the procedure • Press Quick Access/Open Lung Tool EDU-08-0007, ver 00

  4. Four different steps • Recruitment • Find the opening pressure • Find the collapse point • Decremental PEEP titration 3. Re-Recruit • Re-open the lung 4. Keep the lung open • Set “Open Lung PEEP” EDU-08-0007, ver 00

  5. Step 1 – Find opening pressure • Start with normal tidal volume (baseline) (6 ml/kg). • First increase PEEP to (e.g.) 15-20-30 cm/H20 in steps of 5 cm/H20, looking at the compliance curve when increasing PEEP. • Stepwise increase of Pressure Control level above PEEP with intermittent periods of baseline ventilation. • Increase Pressure Above PEEP stepwise in steps of (e.g.) 3 cm/H20 until a decrease in the VTCO2 curve, decrease in compliance curve or no more increase in FRC (baseline of tidal volume). EDU-08-0007, ver 00

  6. Step 1 – Find opening pressure 1. volume (FRC) 2. CO2 elimination 3. compliance EDU-08-0007, ver 00

  7. Step 2 – Find collapse PEEP • Back to baseline ventilation (normal tidal volume, 6 ml/kg) • Choose either Pressure Control or Volume Control Ventilation • Decrease PEEP in steps of 1 cm/H2O, if in VC the tidal volume is constant. If in PC try to keep the tidal volume by decreasing the Pressure above PEEP. • Continue until you get a decrease in the compliance curve. EDU-08-0007, ver 00

  8. Step 2 – Find collapse PEEP Closing PEEP Maximum compliance before lung starts to collapse. EDU-08-0007, ver 00

  9. Step 3 – Re-open the lung • Activate the OLT cursor and define the highest value of • VTCO2 elimination • Tidal volume baseline • Compliance • Look for the EIP at that point and memories. • (Compliance curve may lower first of these 3 curves above due to some overdistention). EDU-08-0007, ver 00

  10. Step 3 – Re-open the lung • 1. Initial PEEP • 2. EIP (opening pressure) EDU-08-0007, ver 00

  11. Step 4 – Keep the lung open • Back to normal tidal volume • Set Open Lung PEEP • Adjust to normal tidal volume • Set Upper Pressure Alarm to be clinically relevant EDU-08-0007, ver 00

  12. Step 4 – Keep the lung open • compliance • before • after 1. Open Lung PEEP 2. Delta pressure (driving pressure) EDU-08-0007, ver 00

  13. Benefits with Stepwise Recruitment • Minimized negative hemodynamic influence • Allows for less stress and resting of lung tissue during periods of baseline ventilation • Possibility to evaluate the pulmonary response to each change of ventilator setting EDU-08-0007, ver 00

  14. Atelectasis No atelectasis Result after a successful recruitment • Increased compliance value • Lower mean airway pressure • Lower Delta-P (lower difference between EIP and PEEP) • Better oxygenation / PF-Ratio EDU-08-0007, ver 00

  15. References • SERVO education – Study Guide Lung Recruitment, PEEP titration and Open Lung Tool • SERVO-i ventilator system Operating Manual EDU-08-0007, ver 00

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