Anthony Tzannes on Calling All Alveoli: How I Recruit

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This document provides an overview of techniques for managing alveoli in patients with respiratory distress. It discusses ensuring open airways and adequate analgesia. Maintaining positive end-expiratory pressure and applying pressure over time can help prevent derecruitment and aid recruitment of alveoli. Proning the patient into a facedown position can improve oxygenation and outcomes. Performing recruitment maneuvers like the staircase maneuver can actively recruit alveoli through increasing inspiratory and expiratory pressures.

Santé & Médecine Business

Calling All Alveoli

Anthony Tzannes
Anthony Tzannes

Overview
Basics
Physio
PEEP + Pressure
Proning
Staircase Recruitment

BODY

Not so Basic

Decompress Abdomen
Analgesia

Physiotherapists
Analgesia targets met
Deep breathing
Coughing
Positioning
Clearing secretions

PEEP + Pressure

Pressure over time
Prevents derecruitment + Aids recruitment

Proning
Improves Oxygenation +
Outcomes

Guérin C, Reignier J, Richard J-C, et al. Prone Positioning in Severe Acute Respiratory Distress Syndrome. N. Engl. J. Med. 2013 May 20

Climb Stairs...
Active recruitment manoeuvre

Tuxen Staircase

Hodgson CL, Tuxen DV, Holland AE, Keating JL, Pilcher D, Thomson TK, Varma D, A Positive Response to a Recruitment
Maneuver With PEEP Titration in Patients With ARDS, Regardless of Transient Oxygen Desaturation During the Maneuver. J
Intensive Care Med 2011;26 41-49.

SRM Notes
Haemodynamic instability @ high
pressures
Can be done in early unilateral disease
Contraindications:
Pneumothorax or high risk of same
ARDS > 1 week
Haemodynamic instability

Summary
Ensure open airways and adequate
analgesia
Increase the pressure (insp & exsp)
Proning
Recruitment manoeuvre

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