Respiratory Therapy - What's the Best Recruitment Maneuver for Atelectasis?
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- čas přidán 25. 07. 2024
- Here we breakdown the various methods of alveolar recruitment. What is sustained inflation? Is it better than an incremental increase in PEEP? What about APRV and HFOV? Tell us what method you most commonly see and prefer. We would love to hear from you.
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Learning a lot from you, coach....
all the way from India
ICU fellow from Canada
I just learned another way of doing a stepwise recruitment starting with PC 15 PEEP 15 R 15 then increase PC by 2 increments until I reach PC 20 peep 15 R 15 each time for 15 breaths then increase PEEP by 2 increments & each time for 15 breaths until I reach PC 20 PEEP 20 & keep it for 15 seconds.I should monitor SPO2 , dynamic compliance & TV . Then I should choose the PEEP that has the best dynamic compliance & TV
Excellent presentation
U have explained it in a very simple bad clear way
Thanks
Great lecture. How would you go about optimizing PEEP in PCV in the stepwise manner you suggested. In PCV, using the Puritan Bennet 980 vent, can you get a plateau pressure or static compliance or is that restricted to volume ventilation.
Nice explaination teacher!
Thanks, you are awesome! Also because you care!
More than you'll ever know!! Thank you for the comment and your time to watch!
Hey Coach, thanks for the video!
In our pediatric ICU in germany we use an increase in PIP and PEEP for a couple of breaths, something like 4-10 breaths, and then slowly reduce settings to where they were before. Measuring mainly SpO2 and tidal volumes/kg while and after doing it to see if we openend an atelectases. We also use sigh breaths on our draeger machines. Sometimes manual recruitment with an ambu-bag with PEEP and PIP mannometer. Also HFOV in case of a CO2 retention.
Cheers, Julian
Very cool. Sounds like you get the job done in various manners. When altering the PIP for those 4-10 breaths, do you lengthen the I time?
@@RespiratoryCoach Not been doing that so far. Will from now on!
@@julianbalks1951 The theory behind the extended I time is the time give for the utilization of the pores of Kohn and canals of Lambert, aka collateral ventilation. Big believer in collateral ventilation associated with alveolar recruitment.
My favorite coach,what happens if the patient is fully sedated from previous mode?
Interesting about the side breath philosophy. I hadn't heard or seen of that one before! In practice, we use APRV quite a lot, and I think we probably will just move to APRV pretty quickly when conventional settings aren't cutting it. I used to hate it, but once I really understood it I actually am a big proponent of it now!
Same! In regards to APRV.
Thank you very much
Have you done a video on how to do a NIF on a vented patient yet?
Another good lecture sir.. question: would you expect to see an immediate increase in static compliance using the step wise recruitment maneuver or will it initially dip and work its way up as alveoli recruit?
Thanks for sharing 👍
Thank you for watching and kindly commenting!
Thank you
Another super class! As a dinosaur that always loved sighs I found your explanation of a low simv rate with a couple of pressure controlled breaths a minute an amazing way of providing sighs in pressure support ventilation.What an excellent way of helping the weaning process! Thank you!
Welcome to the dinosaur club, Kenneth. Getting close to passing the torch. Let's do all we can to leave things better than what we found them. I appreciate your comment!
Thank u soo much
How do you determine what the best mean airway pressure is for your patient? I know that it depends off of a lot of things, I just want to know when my MAP is too high and I'm risking barotrauma or when I need to increase my MAP? What's your strategy for finding optimal MAP if there is such a thing. Great video though!!
Critical thinking and patient assessment. There is no optimal MAP. What we do know though is that while MAP aids in oxygenation and alveolar recruitment, it, along with PIP, is also associated with barotrauma. A combination of monitoring plateau pressures, static compliance, cardiac output, p/f ratio, and pressure volume loops will help provide your patient with an affective level of MAP, while avoiding associated hazards. Great question, Kyle Reece, RRT!
Hi sir! I'm. Enjoying and learning alot in your videos, I would like to know what is the safest recruitment maneuver we can do to a patient. And what to set parameters
Ty
Thank you, Abigail. Glad you are finding the channel helpful. The question is not so much what is the safest maneuver, but rather knowing how to perform the maneuvers safely. Patient monitoring is the key. Like the video stated around the 14:00 minute mark, of the various recruitment maneuver techniques, very little research compares one to the other. Thus, it's hard to identify if one is better or safer than another. Understanding and monitoring for the hazards associated with recruitment maneuvers is the key. I know I didn't answer your question, but I hope this helps. Thank you for watching and commenting.
@@RespiratoryCoach thanks
I will. Always keep note of your advice
Gracias
Is it possible to use stepwise recruitment maneuver in non invasive ventilation
RT from Saudi Arabia , actually we use cpap 40 to 40 , from my experience I use another way and I see it helpful with better outcome with spo2 , increase peep by two and decrease pc by two until I reach peep of 25 or 30 and pc of 10 or 5 for 2-3 minutes with monitoring patient, I believe sustained inflation with VT go in give more recruitment.
Hi!!!! I tend to agree!!! Best wishes from USA!!
Hi im a student from Canada and some of the teachers commented about atelectrauma risk when keeping volume while the recruitment manoeuvre.. still others were agreeing with keeping volume.. Would love your opinions on this! Thanks you ♡
So on the Hamilton Ventilators, the Sigh breath can be used in any mode. I just turned it on in apvCMV, and it gives the patient a breath 30% higher than the targeted Vt every 30 breaths. I checked, and it seems I can do that in all modes with any settings.
Thank you for sharing this information. I wonder how it increases the breath size in PC? Obviously, it increases insp pressure, but by how much? Any idea?
@@RespiratoryCoach let me look deeper into this and get back to you. I will go play with the vent next shift with a test lung.
@@RespiratoryCoach Ok so the vent will allow me to do it in any and all modes, including ASV. I went to the manual and this is all I could find. It says "Sigh Breaths delivered at a regular interval (every 50 breaths) at a pressure up to 10 cmH2O higher than non-sigh breaths,
as allowed by the Pressure alarm limit". What are your thoughts on this?
Side note: About 6 months ago, I starting using the sigh feature on some patients, and I don't know if it's coincidence or not, but I have noticed improved oxygenation in patients we have had trouble with.
Thank you for lovely videos. Ireally appreciate. Can we use long I time in AC AC mode to recruit the alveoli. Second thing I need to know what about in consolidation in covid 19 patients like viral pneumonia.Can we use these maneuver to improve their oxygenation as there too intrapulmonary shunting happens.
Hello again. You can, but it is best achieved by adding an inspiratory pause, rather than excessively decreasing flow, which can lead to flow hunger!!! And yes, any disease presenting with consolidation and atelectasis can benefit from these maneuvers.
can you do a video while you're at work and show the machine when doing this please? thank you :)
I can not. My channel is intentionally and distinctly separate from my obligation to my employer. I understand the reason for your request, but I prefer to avoid any conflicts of interest.
I want to see it also in actual machine 😔
Hi Coach, can you consider making videos on neonatal/pediatric ventilation strategies and differences compared to an adult?
Great video though!
Hi, Man. I don't work specifically with neo/pedi, but hopefully I can get my neo/pedi expert to join me soon for a neo/pedi specific video. Cross your fingers. Thanks for watching!
Hey Coach when you apply the step wise maneuver, what TV do you set? 6 ml/kg or do you decrease TV as you increase PEEP?
Hey Kostas, that would be a great research topic. The times I've implemented it the tidal volume remained on 6ml/kg. Great question!
Hi, from Québec here! Teachers at our school mentioned "atelectrauma" about this! Still wondering 🤔.. We follow pressure/volume loop so we can try and prevent this and by decreasing TV by 1 ml/kg keeping it in a 4-6 ml/kg range.
Any evidence of recruitment maneuver in non invasive ventilation
Lot of question about this on tmc. Maybe that why you’ll getting so many questions
Maybe so. Thanks for sharing that, Tracey.
I am working in saudi arabia as respiratory therapist sir and we are applying sustained inflation
Very cool. I tend to lean that way too. Thank you for watching and commenting. Keep up the strong work in Saudi Arabia!!!
What is th mode you set in doing sustained inflation? What are the parameters to set
Thank
Thank you. I came across the open lung approach. What is that?
Open lung approach (OLA) is a mechanical ventilation strategy that focuses on sustained alveolar recruitment with minimal inflation and deflation of the alveoli. So, increased peep with small tidal volumes. Optimal peep and permissive hypercapnia are two common terms associated with OLA of mechanical ventilation, specifically in ARDS patients.
@@RespiratoryCoach So that's pretty much like the stepwise approach but with permissive hypercapnia?
When you say static pressure it sounds like you are referring to plateau pressure. Static and plateau are different measurements. Was I hearing incorrectly?
Plateau pressure is the pressure used to calculate static compliance. You are correct. They are not the same, but most definitely connected in concept. Sorry if I confused you in the use of these terms.
Can you explain the naepp asthma steps?
Hi Teresa, anything specific related to the naepp asthma steps? I can repeat what each step is, but I don't think that's what you're looking for. Let me know.
Respiratory Coach I really was just looking for a good explanation of the step up in medications.