anthony tzannes on calling all alveoli: how i recruit

Anthony TzannesAnthony Tzannes

Calling All AlveoliCalling All Alveoli

Overview

Basics

Physio

PEEP + Pressure

Proning

Staircase Recruitment

BODY

BasicsEnsure

patent

airways

to alveoli

Not so Basic

Decompress Abdomen

Analgesia

Physiotherapists

Analgesia targets met

Deep breathing

Coughing

Positioning

Clearing secretions

PEEP + Pressure

Pressure over timePrevents derecruitment + Aids recruitment

ProningImproves Oxygenation + Outcomes

Guérin C, Reignier J, Richard J-C, et al. Prone Positioning in Severe Acute Respiratory Distress Syndrome. N. Engl. J. Med. 2013 May 20

Climb Stairs...Active recruitment manoeuvre

Tuxen Staircase

Hodgson CL, Tuxen DV, Holland AE, Keating JL, Pilcher D, Thomson TK, Varma D, A Positive Response to a Recruitment Maneuver With PEEP Titration in Patients With ARDS, Regardless of Transient Oxygen Desaturation During the Maneuver. J Intensive Care Med 2011;26 41-49.

SRM NotesHaemodynamic instability @ high pressures

Can be done in early unilateral disease

Contraindications:

Pneumothorax or high risk of same

ARDS > 1 week

Haemodynamic instability

Questions?

Summary

Ensure open airways and adequate analgesia

Increase the pressure (insp & exsp)

Proning

Recruitment manoeuvre