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Lung Recruitment in General Anesthesia

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.

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Ida Sutawan
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54 views2 pages

Lung Recruitment in General Anesthesia

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.

Uploaded by

Ida Sutawan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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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

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