When PEEP is optimized, recruitment manoeuvres are either poorly effective [ 46] or deleterious, inducing overinflation of the most compliant lung regions [ 47] and haemodynamic instability and worsening pulmonary shunt by redistributing pulmonary blood flow towards non-aerated lung regions [ 48].
In the optimized recruitment strategy, PEEP was adjusted based on Pplat and was kept as high as possible without increasing the inspiratory Pplat above 28 to 30 cm H2O.
In addition, if the continuous distending pressure (CDP) is optimized following a stepwise recruitment maneuver, the more compliant lung regions are less susceptible to static hyperinflation [ 3, 5, 6], thereby reducing lung strain and ventilation-induced inflammation [ 7, 8].
It's very heavily optimized.
Patients and methods Interventional prospective study, in single-center ICU, was performed in patients with moderate-to-severe ARDS (PaO2/FiO2 ratio <150 after a 6-h period of optimized CMV for maximal alveolar recruitment).
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e-Recruitment Please note that it is recommended that you use Microsoft Internet Explorer rather than different web browser (Mozilla Firefox, Opera, Chrome, Safari - Mac computer) because you will not be able to get the optimized version of the e-Recruitment system.
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In addition to increasing the recruitment target, the approach and follow-up procedure was optimized based on recent evidence [ 60].
Despite optimized protective mechanical ventilation and other adjuvant treatment (i.e. PP, inhaled nitric oxide, recruitment maneuvers), 44 patients received VV-ECMO during the study period for refractory acute respiratory distress syndrome.
