Open up the lung, but smooth and gentle, please!

摘要

Mechanically ventilated patients usually need sedation, analgesic agents, and sometimes paralysis to tolerate the tracheal tube and positive pressure ventilation. These patients often experience the collapse of smaller airways and lung parenchyma, commonly in the dependent lung regions, which contributes to atelectasis, intrapulmonary shunt, impaired oxygenation, and hypercapnia, especially in patients suffering from acute lung injury . Furthermore, in the current era of "lung protective strategy," the modern means of ventilation is characterized by reducing tidal volume and limiting plateau pressure, which may prevent end-inspiratory overdistension and end-expiratory cycling collapse, but which, on the other hand, may also promote alveolar derecruitment . To solve such a dilemma the use of recruitment maneuvers (RMs) has been advocated in recent years to reverse low tidal volume related derecruitment. There has been a triumphant advance in many ICUs of the "open lung" concept: elevation in the peak inspiratory pressure to 60 cmH20 for10-30 breaths during pressure controlled ventilation followed by a "titration" of a high PEEP level . The slogan "Open the lung and keep it open" has been sounded in scientific literature, symposia, and clinical discussions.