alveoli recruitment

dorimar, BSN, RN · May 9, 2007

we of course use the roto prone bed (as the prone position has been proven to immediatey recruit alveoli). Also our Servo vents have an alveolar recruitment mechanism that can (when ordered) gradually increase the peep to max therapuetic range. The vents are "smart ventilators" that can sense the pressure. Once alveolar recruitment is done, it is important not to break the circuit (disconnecting for road trips, suctioning, etc.) , so as not to lose it (alveolar collapse)

luvtheOBX · May 15, 2007

Or you could try offering sign on bonuses.

Sorry, I've been studying too hard (i take the CCRN exam today) so forgive my momentary craziness.

We also use the Rotoprone bed. I was wondering though, while I was studying for this test the book said ARDS patients should have a low tidal volume and a high PEEP. I am pretty sure we use a higher TV also. Which do you do?

jewelcutt · May 15, 2007

You could get the bilevel vent, whose goal is ultimate alveolar recruitment. functions on the concept of constant high peep (~ 30) that allows spont ventilation over by the patient. it sounds weird but has proven miraculous in many patients. you should look up the lecture series by michael mitton.

phiposurde · May 15, 2007

That's our hospital protocol:

"

Using the Evita 4 and Savina ventilators

1. Wash hands pre and post procedure.

2. The plateau pressure can be determined in one of two ways:

a) Place patient on CMV with Autoflow and set the tidal volume to 12 mL/kg IBW. Adjust

the high pressure alarm if necessary. Push screen freeze at the beginning of a new

screen cycle. At the beginning of the next inspiration, press and hold the inspiratory

hold button until a stable plateau pressure is achieved. Repeat this process 3 times,

then calculate the average plateau pressure

b) Place the patient on PCV+ and set the inspiratory pressure to achieve a tidal volume

of 12 mL/kg IBW. Push screen freeze at the beginning of a new screen cycle. At the

beginning of the next inspiration, press and hold the inspiratory hold button until a

stable plateau pressure is achieved. Repeat this process 3 times, then calculate the

average plateau pressure.

3. After determining the pressure in step #3, place the patient on APRV with the following

settings. Silence the alarm to avoid unnecessary nuisance alarms.

* Apnea alarm 60 seconds

* Phigh- as determined by the procedure outlined in step 2 (30-50 cmH20)

* Plow- normal ventilation PEEP level

* Thigh- 30 seconds

* Tlow- 2.0 seconds

4. Monitor the patient throughout the procedure. Terminate the lung recruitment maneuver if

any of the termination criteria are met.

5. Return the patient to the original ventilator settings immediately after completion of the

maneuver.

6. If the patient tolerated the procedure (no termination criteria met), maintain the patient on

the original ventilator settings for 1 minute. Then repeat the maneuver with a plateau of 1

minute. Pre-silence the alarms and place the patient in APRV with the following settings.

Due to Thigh being limited at 30 seconds, a Tlow of 0.1 seconds is used to minimize the

change in pressure during the plateau. Because of this, the Respiratory Therapist must

time the 60 seconds, as the change on the pressure waveform is easily missed.

* Apnea alarm 60 seconds

* Phigh-as determined in step 2 (30-50 cmH20)

* Plow-normal ventilation PEEP level

* Thigh- 30 seconds

* Tlow- 0.1 seconds

7. Return the patient to the original ventilator settings for 1 minute. If the patient tolerated the

60 second maneuver, repeat a third time.

8. Ensure the patient's settings and alarms are adjusted to pre-maneuver values.

9. Document performance of the procedure and patient tolerance in the patient's chart."

ECMOismygame · Jun 7, 2007

Or you could try offering sign on bonuses.
Sorry, I've been studying too hard (i take the CCRN exam today) so forgive my momentary craziness.
We also use the Rotoprone bed. I was wondering though, while I was studying for this test the book said ARDS patients should have a low tidal volume and a high PEEP. I am pretty sure we use a higher TV also. Which do you do?

lung protection strategies for ARDS patients include SMALL VTs and high PEEP.

also an easier way to find plateu pressure is to (if on PC) look at the flow waveform. if flow is hitting zero before the end of inspiration, your PIP/set pressure and PLAT pressures are the same (this is the whole point of PC anyways)

btw: CMV with autoflow is PRVC, which is a pressure limited-volume targeted mode, essentially a PC mode that can *usually* guarantee a set VT. PLAT pressure should equal the set Pressure/PIP, just like on a pressure controlled mode.