Hello everybody,

Does anyone use lung recruitment maneuvers during CMV or CPAP to achieve optimal FRC and oxygenation? If so, do you have a procotol and/or any practical tips? I've read some articles and the Cochrane Review, but I'd to hear your opnion..

Thanks! 

Hi Flavio! I would generally not, but work work with ventilator pressures such as PEEP/CDP to achieve FRC. But I think others may do, let’s hope more people join the discussion.

Please share the reviews

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009969.pub2/full

I have done this in our medical NICU patients who have become de-recruited for any number of reasons, but not routinely on preemies (I mostly work in an outborn NICU that, in many ways, sees pathology closer to a pediatric ICU just in neonates who may incidentally be premature and are often coming to us at or new term corrected or later). No protocol, just recognition that this is an issue and taking the fellow and RRT to bedside and performing a series of recruitment maneuvers either with vent or by hand bagging.

There is the maneuver done on HFOV in the IN-REC-SUR-E trial. could be adapted to CMV shouldn't be much different. I don't think there is a solid recruitment maneuver out there for the neonatal population. None of the parameters (LUS, dyn Cyn changes) have been widely accepted yet. Simply put... I don't think we really know what's the optimal PEEP and how to set it.