Calling All Alveoli

Anthony Tzannes
Anthony Tzannes
Overview
Basics
Physio
PEEP + Pressure
Proning
Staircase Recruitment

BODY
Basics
Ensure
patent
airways
to alveoli
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 Respi...
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 Re...
SRM Notes
Haemodynamic instability @ high
pressures
Can be done in early unilateral disease
Contraindications:
Pneumothora...
Questions?
Summary
Ensure open airways and adequate
analgesia
Increase the pressure (insp & exsp)
Proning
Recruitment manoeuvre
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Anthony Tzannes on Calling All Alveoli: How I Recruit

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Dr Anthony Tzannes speaks at Bedside Critical Care Conference 4 about his strategies for alveolar recruitment. The full podcast can be found on www.intensivecarenetwork.com

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  • Remember, best recruitment may be by extubation and allow Pt to swear etc.
  • RIght Main Bronchus Intubation
    Blocked ETT
    Have open airway channel to all alveoli aim to recruit
  • Proseva Study - 466 Pt, early proning for 16/24 vs supine. Mortality reduced by roughly half
  • PCV, with insp pressure 15 above PEEP: PEEP 20; 30; 40 2-3 min. at each
    Then drop to 25 and down by 2.5 from there @ 3 min. intervals
  • Anthony Tzannes on Calling All Alveoli: How I Recruit

    1. 1. Calling All Alveoli Anthony Tzannes Anthony Tzannes
    2. 2. Overview Basics Physio PEEP + Pressure Proning Staircase Recruitment BODY
    3. 3. Basics Ensure patent airways to alveoli
    4. 4. Not so Basic Decompress Abdomen Analgesia
    5. 5. Physiotherapists Analgesia targets met Deep breathing Coughing Positioning Clearing secretions
    6. 6. PEEP + Pressure Pressure over time Prevents derecruitment + Aids recruitment
    7. 7. 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
    8. 8. Climb Stairs... Active recruitment manoeuvre
    9. 9. 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.
    10. 10. 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
    11. 11. Questions?
    12. 12. Summary Ensure open airways and adequate analgesia Increase the pressure (insp & exsp) Proning Recruitment manoeuvre

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