Scribd Logo
Upload

Welcome to Scribd!

  • Lung Recruitment in General Anesthesia

    Uploaded by

    Ida Sutawan
    11 views2 pages
    1. Lung recruitment maneuvers during general anesthesia can help reduce postoperative pulmonary complications, especially in high-risk patients. 2. The document outlines recommendations for lung recruitment including hemodynamic preconditioning, a recruitment phase using high inspiratory pressures and PEEP, and PEEP titration to find the optimal level. 3. Key goals of lung protective ventilation include tidal volumes of 6-8 ml/kg, inspiratory pause over 20%, and driving pressure under 13 cmH2O to protect lung tissue during surgery.

    Original Description:

    Lung requitment

    Original Title

    Lung Recruitment In General Anesthesia

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    1. Lung recruitment maneuvers during general anesthesia can help reduce postoperative pulmonary complications, especially in high-risk patients. 2. The document outlines recommendations for lung recruitment including hemodynamic preconditioning, a recruitment phase using high inspiratory pressures and PEEP, and PEEP titration to find the optimal level. 3. Key goals of lung protective ventilation include tidal volumes of 6-8 ml/kg, inspiratory pause over 20%, and driving pressure under 13 cmH2O to protect lung tissue during surgery.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    11 views2 pages

    Lung Recruitment in General Anesthesia

    Uploaded by

    Ida Sutawan
    1. Lung recruitment maneuvers during general anesthesia can help reduce postoperative pulmonary complications, especially in high-risk patients. 2. The document outlines recommendations for lung recruitment including hemodynamic preconditioning, a recruitment phase using high inspiratory pressures and PEEP, and PEEP titration to find the optimal level. 3. Key goals of lung protective ventilation include tidal volumes of 6-8 ml/kg, inspiratory pause over 20%, and driving pressure under 13 cmH2O to protect lung tissue during surgery.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 2

    LUNG RECRUITMENT IN GENERAL ANESTHESIA

    B. Contraindication
    Reminder: lung recruitment must be individualized for each patient Absolute Relative
    Uncontrolled hypotension ARDS
    A. Indication Head trauma Poor chest wall elasticity
    ARISCAT risk assessment tool for PPC Intracranial hypertension Emphysema
    https://anesthesiology.pubs.asahq.org/data/journals/jasa/9309 Open eye surgery Patients 6-25 years old and
    78/11tt01.png Undrained pneumothorax healthy lungs
    Bronchospasm Short duration of surgery
    Patient characteristics Score Pulmonary emphysema Mixed asthma-COPD
    Age Lung bullae
    < 50 0 Leaks
    51-80 3
    García-Fernández J, Romero A, Blanco A, Gonzalez P, Abad-
    > 80 16
    Gurumeta A, Bergese SD. Maniobras de reclu-tamiento en
    Preoperative SpO2
    > 96% 0 anestesia: ¿qué más excusas para no usarlas? Rev Esp Anestesiol
    91-95% 8 Reanim. 2018. https://doi.org/10.1016/j.redar.2017.12.006∗
    < 90% 24
    Respiratory infection in the last month 1. Beach chair position before induction
    No 0 2. Set optimal FiO2
    Yes 17 a. 40% or below after intubation
    Hb < 10 g/dL b. Use lowest FiO2 to maintain SpO2 > 94%
    No 0 c. Treat the patient, not the lungs!
    Yes 11 3. Maintain TV 6-8 ml/kg ideal body weight
    Surgical incision 4. Lung recruitment
    Peripheral 0 a. Hemodynamic preconditioning
    Upper abdominal 15
    Pinsp 15 15 15 15
    Intrathoracic 24
    Duration of surgery PEEP 5 10 15 20 (pedia 15)
    < 2 hours 0 Breaths 3 3 3 3
    2-3 hours 16 I:E 1:2 1:2 1:2 1:2
    > 3 hours 23 RR 12 12 12 12
    Emergency procedure? If (+) BP/HR/CO changes, consider IV
    No 0 infusion/vasopressors and repeat this step
    Yes 8 b. Recruitment phase
    < 26 points – low risk Pinsp 20 (pedia 15)
    26-44 points – moderate risk PEEP 20 (pedia 15)
    > 45 points – high risk Breaths 10
    I:E 1:2
    RR 12
    May be higher for obese, lower for pedia/healthy adult
    c. PEEP titration
    Pinsp 12 12 12 12 12 12 12
    PEEP 18 16 14 12 10 8 6
    Breaths 3 3 3 3 3 3 3
    I:E 1:2 1:2 1:2 1:2 1:2 1:2 1:2
    RR 12 12 12 12 12 12 12
    Compl ? ? ? ? ? ? ?
    Record compliance values during each PEEP titration
    5. Set optimal PEEP
    Find PEEP level with highest compliance value, add 1-2 cmH2O
    6. Lung protective ventilation
    a. TV 6-8 ml/kg
    b. Inspiratory pause > 0.2 seconds (10-20%)
    c. Driving pressure (Pplat - PEEP) < 13 cmH2O
    d. Adjust TV and RR to maintain desired EtCO2 (e.g. 30-40
    mmHg)
    7. Consider low FiO2 (< 40%) during emergence if appropriate
    8. Optimal positioning during emergence (i.e. head up)
    9. Avoid apneic period during emergence

    Young et al (2019). Lung protective ventilation for the surgical patient:


    international expert panel-based consensus recommendations. BJA
    doi:10.1016/j.bja.2019.08.017

    You might also like