Critically evaluate the role of ventilatory recruitment manoeuvres in the critically ill.
Anything reasonable here including “I do not perform recruitment maneuvers”
If a candidate was unaware of the ART trial and described a routine use of Recruitment Maneuvers they were should be marked down at the examiners discretion.
This question was overall answered well by many candidates. A logical explanation of the rationale for recruitment and its benefits as well as possible harm along with a mention of recent literature was required to score marks. Good candidates understood that although oxygenation may improve with recruitment maneuvers mortality benefit was not demonstrated in any trials. The risk of possible harm from the ART study as well PHARLAP ceasing recruitment due to this was noted by some candidates.
Rationale for the use of recruitment manoeuvres
Advantages of recruitment manoeuvres
Disadvantages of recruitment manoeuvres
Evidence for and against recruitment manoeuvres
Cavalcanti, Alexandre Biasi, et al. "Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial." Jama 318.14 (2017): 1335-1345.
Hodgson, Carol L., et al. "A randomised controlled trial of an open lung strategy with staircase recruitment, titrated PEEP and targeted low airway pressures in patients with acute respiratory distress syndrome." Critical care 15.3 (2011): R133.
Hodgson, Carol, et al. "Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation." The Cochrane Library (2016).
Villar, Jesús, Fernando Suárez-Sipmann, and Robert M. Kacmarek. "Should the ART trial change our practice?." Journal of thoracic disease 9.12 (2017): 4871.
Cavalcanti, Alexandre Biasi, Marcelo Britto Passos Amato, and Carlos Roberto Ribeiro de Carvalho. "Should the ART trial change our practice?." Journal of thoracic disease 10.3 (2018): E224.
Moran, I., et al. "Recruitment manoeuvres in acute lung injury/acute respiratory distress syndrome." European Respiratory Journal 22.42 suppl (2003): 37s-42s.
Gattinoni, Luciano, and Antonio Pesenti. "The concept of “baby lung”." Applied Physiology in Intensive Care Medicine. Springer, Berlin, Heidelberg, 2006. 303-311.
Rocco, Patricia RM, Paolo Pelosi, and Marcelo Gama De Abreu. "Pros and cons of recruitment maneuvers in acute lung injury and acute respiratory distress syndrome." Expert review of respiratory medicine 4.4 (2010): 479-489.
Kasim, Ihsan, et al. "A recruitment breath manoeuvre directly after endotracheal suction improves lung function: An experimental study in pigs." Upsala journal of medical sciences 114.3 (2009): 129-135.
Morrow, Brenda, Merle Futter, and Andrew Argent. "A recruitment manoeuvre performed after endotracheal suction does not increase dynamic compliance in ventilated paediatric patients: a randomised controlled trial." Australian Journal of Physiotherapy 53.3 (2007): 163-169.
Hodgson, Carol L., et al. "Maximal recruitment open lung ventilation in acute respiratory distress syndrome (PHARLAP). A phase II, multicenter randomized controlled clinical trial." American journal of respiratory and critical care medicine 200.11 (2019): 1363-1372.