tailieunhanh - Báo cáo y học: "Do recruitment maneuvers simply improve oxygenation"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Do recruitment maneuvers simply improve oxygenation? | Valenza Critical Care 2010 14 173 http content 14 4 173 CRITICAL CARE COMMENTARY L__ Do recruitment maneuvers simply improve oxygenation Franco Valenza See related research by Constantin etal. http content 14 2 R76 Abstract Recruitment maneuvers have been the subject of intense investigation. Their role in the acute care setting is debated given the lack of information on their influence on clinical outcomes. Oxygenation improvement is often a striking effect together with changes of respiratory mechanics. However hemodynamic compromise is frequently associated with the maneuver sometimes even barotrauma. Another possible downside is bacterial translocation secondary to lung overdistention as suggested by experimental and initial clinical data. When a recruitment maneuver is performed the pathophysiological consequences of lung recruitment should guide clinicians more than oxygenation improvement alone. The investigation reported by Constantin and colleagues in a recent issue of Critical Care 1 dwells on a philosophy summarized by Lachmann years ago in an aphorism still current among intensive care practitioners Open up the lung and keep it open 2 . Along the learning curve of the ventilator settings of patients with acute lung injury the pivotal role of positive end-expiratory pressure PEEP soon became clear. It took some time to understand that PEEP maintains the lung open once and if previously opened. Since then several investigators have focused on the recruitment maneuver proposing different strategies with the common rationale of needing to open up the lung. The study by Constantin and colleagues is one such investigation their randomized controlled trial aimed to evaluate improvement of oxygenation after a recruitment maneuver performed soon after intubation in the ICU. The setting is new and Correspondence Università degli Studi di Milano Fondazione IRCCS Policlinico Ca Granda Via F. Sforza 35 201 22

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