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Despite complementary mechanisms, prone position and appropriate PEEP exert their positive effects on lung mechanics independently of each other.
Second, lung recruitment maneuvers may aid in the choice of appropriate PEEP setting [ 34].
To date, few methods have been accepted for clinical use to set the appropriate PEEP.
Furthermore, the main goal of setting up appropriate PEEP is to minimize cyclic recruitment and derecruitment.
The selection of the appropriate PEEP level was performed by increasing PEEP in steps of 2 cmH2O.
Higher than traditional PEEP levels together with lung-recruiting maneuvers seems to be a way to find an appropriate PEEP level [ 16].
Another limitation is that our indicators of oxygen saturation and static compliance to find an appropriate PEEP level might be insensitive to detect the collapsing pressure of the lung.
Thus, in patients undergoing low tidal volume ventilation, a decreased ventilated lung area could trigger the use of appropriate PEEP levels and/or recruitment maneuvers to prevent or treat atelectasis.
Once opened, the applied end-expiratory pressure should be released in stages, using oxygenation and/or expiratory deflation mechanics to identify the appropriate PEEP that sustains nearly full recruitment.
Another potential role for lung recruitment maneuvers is in the evaluation of the appropriate PEEP and tidal volume combination for a patient, and to gauge responsiveness to PEEP [ 20].
As demonstrated by Borges and colleagues [ 22], the maintenance of appropriate PEEP during the recruitment phase, above closing pressures (commonly above 15 cmH2O), is an essential component of recruitment maneuver, enhancing the recruitment effects of high plateau inspiratory pressures.
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