作者: Munir Karjaghli
Zones of collapsed and consolidated alveoli in the most dependent lung frequently require airway opening pressures of more than 35–40 cmH2O to recruit (
Knowledge of the percentage of potentially recruitable lung may be important for establishing the therapeutic efficacy of PEEP. Setting levels of PEEP independently of that knowledge may reduce the possible benefits of PEEP, while use of high PEEP levels in patients with a low percentage of potentially recruitable lung provides little benefit and may actually be harmful (
Assessing lung recruitability before changing the patient’s position from supine to prone helps you predict the outcome of the prone positioning and determine the strategy. If the assessment shows low recruitability, the patient can be changed to the prone position and no recruitment maneuver is performed. If the assessment shows high recruitability, the patient remains in the supine position and a recruitment maneuver is performed.
The P/V Tool available as a standard or optional feature on HAMILTON-G5/S1 (
Use the following settings to generate a low-flow P/V curve:
|End PEEP||0 cmH2O
Note: When prompted whether to change the PEEP setting after the maneuver, touch No.
|Ramp speed||2 cmH2O|
Use the following criteria to help you assess the patient‘s potential for lung recruitment.
a. Determine the shape of the inspiratory curve.
Upward convexity means there is low potential for recruitment
Upward concavity means there is high potential for recruitment
b. Assess the volume difference at 20 cmH2O. The difference must be > 500 ml (
Step 3: If either one or both of these two criteria is met, a recruitment maneuver is warranted.
Step 4: If neither criteria is met, the patient‘s lung is not recruitable. In this case: