The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

ASSESSMENT OF VARIABILITY IN RECRUITMENT MANEUVER DELIVERY AND UNDERSTANDING.

Michelle R. Moore; Respiratory Care, Children's Hospital of UPMC, Pittsburgh, PA

Background: While no current guidelines exist regarding style and technique of recruitment maneuvers (RM), an unrecruited lung is at risk of atelectrauma, requires a higher fraction of inspired oxygen (FIO2) as well as higher ventilating pressures which in turn, increases the risk of barotrauma, chance of infection, decreased surfactant production and repeated inflammatory mediator response. This inflammatory response and the release of cytokines may to contribute to Multi System Organ Failure (MSOF) and possibly be fatal. Having observed a variety and inconsistencies of RM, a survey was conducted to determine RM delivery preferences and comprehension. Method: An email survey was sent to all staff therapists. Critical Care Medicine (CCM) physicians and Registered Nurses (RN) were surveyed individually with the following questions. 1. I would like to know if you were going to recruit a patient's lungs and had the freedom to perform it the way YOU prefer, would you: 2. Recruit with a Mapleson (Anesthesia) Bag? 3. Recruit with the vent? 4. For either one, is there anything specific or a system you prefer to follow? (i.e. increase/hold PEEP, PIP or Vt, add inspiratory hold, increase I time...etc?) 5. Is there a specific criterion you monitor or evaluate to determine that the lung has been recruited? Results: Of 58 staff members responding to the RM survey, 79% preferred to use a Mapleson (Anesthesia) Bag and eleven different styles of bagging described , 10% Preferred to wait for RT recommendations, 3% Preferred to use the Ventilator, 7% Preferred other methods: (CPT & suction). A variety of descriptions, length of time used/repeated, pressures (PIP & PEEP) and the values monitored to determine a successful RM were reported. Only 1 respondent mentioned the necessity of clamping the endotracheal tube (ETT) before transferring back to the ventilator and only 1 mentioned SpO2 was the deciding factor of a successful RM. Conclusion: The techniques used to deliver RMs differed greatly among staff members. It is suggested to expand this as a quality improvement project to all CCM physicians, RTs and RNs with a listing and description of Evidence Based Medicine (EBM) suggested styles of RM and information regarding possible benefits and risks to the patient. Additionally, development of a RM protocol may decrease the variances in RM style and possibly decrease the risk of injury to the patient.
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