Lung Recruitment

Lung Recruitment

What is a lung recruitment maneuver?

• A sustained inflation performed on mechanically ventilated patients at an airway pressure performed to recruit (reopen) atelectatic alveoli.

Indications for lung recruitment therapy include:

1. Prolonged recovery time following endotracheal tube (ETT) suctioning
2. Atelectasis on chest x-ray
3. Inability to wean FiO2 for greater than 12 hours
4. Any critically ill patient on mechanical ventilation

The Respiratory Care Practitioner (RCP) will:

• Verify the physicians order
• Identify the patient and explain the therapy rationale
• Document intervention in Compass

Monitor

• SaO2
• Heart Rate
• Blood Pressure
• CVP
• LAP
• IMPORTANT
  • Lung recruitment therapy should be delivered every 4-6 hours as ordered
  • If an elevated CVP is noted during the procedure, terminate and notify MD for direction.
  • All Vital signs should be monitored during treatment and if abrupt changes occur, treatment should be stopped and MD notified for direction.
  • NOTE: The RCP must remain at the bedside for the entire duration of the recruitment maneuver. If the RCP must respond to another emergency, or if the patient becomes unstable during the maneuver,terminate the lung recruitment maneuver

CONTRADICTIONS

• Cardiac anomalies (exceptions exist - discuss with CCU Intensivist)
• Increased intracranial pressure (ICP)
• Active air leak
• Patients with Pulmonary Hypertension

COMPLICATIONS

Possible complications associated with the lung recruitment maneuver include:

• Pneumothorax
• Hemodynamic instability
• Transient hypercarbia
• Increased ICP

Shall be performed on the Ventilator or Manually

Ventilator

1. Increase the apnea time to 45 seconds.
2. Note the PIP in the current mode.
3. Change the mode to Pressure Support/Continuous Positive Airway Pressure (PS/CPAP).
4. Increase the PEEP to the current PIP from the previous mode.DO NOT exceed a PEEP of 30 cm H2O.
5. Turn the pressure support to zero.
6. Maintain this setting for up to 30 seconds as tolerated.
7. Return the patient to the previous mode they were in prior to the recruitment maneuver.
8. Document and/or notify physician of patient response and any complications or adverse reactions to therapy in Compass.

Manual with Hyperinflation Bag (to be used for ordered bag suctioning, and/or if the patient is unable to support his/her Minute volume. Ie: on a paralytic.)

1. Gather supplies
1. Anesthesia bad with manometer
2. Suction set up with appropriate catheter size.
2. Observe standard precautions
3. Coordinate all therapy with ECMO Specialist (If Applicable)
4. Give (6) 5 seconds inflation holds via an anesthesia bag at a PIP equal to PIP on current mode. Bag the patient in between inspiratory hold attempts with a respiratory rate to support the patients needed minute ventilation (Ve).
5. Return patient to ventilator
6. Document and/or notify physician of patient response and any complications or adverse reactions in Compass.