Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Bench-to-bedside review: Recruitment and recruiting maneuvers. | Critical Care February 2005 Vol 9 No 1 Lapinsky and Mehta Review Bench-to-bedside review Recruitment and recruiting maneuvers Stephen E Lapinsky1 and Sangeeta Mehta2 1Site Director Intensive Care Unit Mount Sinai Hospital Associate Professor Interdepartmental Division of Critical Care University of Toronto Toronto Canada 2Research Director Intensive Care Unit Mount Sinai Hospital Assistant Professor Interdepartmental Division of Critical Care University of Toronto Toronto Canada Corresponding author Stephen E Lapinsky Published online 18 August 2004 This article is online at http content 9 1 60 2004 BioMed Central Ltd Critical Care 2005 9 60-65 DOI cc2934 Abstract In patients with acute respiratory distress syndrome ARDS the lung comprises areas of aeration and areas of alveolar collapse the latter producing intrapulmonary shunt and hypoxemia. The currently suggested strategy of ventilation with low lung volumes can aggravate lung collapse and potentially produce lung injury through shear stress at the interface between aerated and collapsed lung and as a result of repetitive opening and closing of alveoli. An open lung strategy focused on alveolar patency has therefore been recommended. While positive end-expiratory pressure prevents alveolar collapse recruitment maneuvers can be used to achieve alveolar recruitment. Various recruitment maneuvers exist including sustained inflation to high pressures intermittent sighs and stepwise increases in positive end-expiratory pressure or peak inspiratory pressure. In animal studies recruitment maneuvers clearly reverse the derecruitment associated with low tidal volume ventilation improve gas exchange and reduce lung injury. Data regarding the use of recruitment maneuvers in patients with ARDS show mixed results with increased efficacy in those with short duration of ARDS good compliance of the chest wall and in extrapulmonary ARDS. In this review we discuss the .
