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Anthony TzannesAnthony Tzannes
Calling All AlveoliCalling All Alveoli
Overview
Basics
Physio
PEEP + Pressure
Proning
Staircase Recruitment
BODY
BasicsEnsure
patent
airways
to alveoli
Not so Basic
Decompress Abdomen
Analgesia
Physiotherapists
Analgesia targets met
Deep breathing
Coughing
Positioning
Clearing secretions
PEEP + Pressure
Pressure over timePrevents derecruitment + Aids recruitment
ProningImproves Oxygenation + Outcomes
Guérin C, Reignier J, Richard J-C, et al. Prone Positioning in Severe Acute Respiratory Distress Syndrome. N. Engl. J. Med. 2013 May 20
Climb Stairs...Active recruitment manoeuvre
Tuxen Staircase
Hodgson CL, Tuxen DV, Holland AE, Keating JL, Pilcher D, Thomson TK, Varma D, A Positive Response to a Recruitment Maneuver With PEEP Titration in Patients With ARDS, Regardless of Transient Oxygen Desaturation During the Maneuver. J Intensive Care Med 2011;26 41-49.
SRM NotesHaemodynamic instability @ high pressures
Can be done in early unilateral disease
Contraindications:
Pneumothorax or high risk of same
ARDS > 1 week
Haemodynamic instability
Questions?
Summary
Ensure open airways and adequate analgesia
Increase the pressure (insp & exsp)
Proning
Recruitment manoeuvre