The use of low tidal volume ventilation and low to moderate PEEP levels is a widespread strategy to ventilate patients with non injured lungs during general anesthesia and in intensive care as well with mild to moderate acute respiratory distress syndrome (ARDS). Higher PEEP levels have been recommended in severe ARDS. Due to the presence of alveolar collapse, recruitment maneuver (RMs) by causing a transient elevation in airway pressure (i.e. transpulmonary pressure) has been suggested to improve the lung inflation in the not and in the poor inflated lung regions. Various type of RMs such as sustained inflation at high pressure, intermittent sighs and stepwise increases of PEEP and/or airway plateau inspiratory pressure have been proposed. The use of RMs has been associated with mixed results in terms of physiological and clinical outcomes. The optimal method for RMs has not yet been identified. The use of RMs is not standardized and left to the individual physician experience. Similarly to ARDS patients, RMs have been proposed to improve lung aeration during general anesthesia. Aim of this clinical review is to present the clinical evidence of RMs in patients during general anesthesia and with ARDS and as well their potential biological effects in experimental models of acute lung injury.
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|Titolo:||Recruitment maneuvers in acute respiratory distress syndrome and during general anesthesia.|
|Data di pubblicazione:||2016|
|Appare nelle tipologie:||1.1 Articolo in rivista|