Recruitment Maneuvers in ARDS

[@romeolhk1008]

Man you are the hero! Easy to understand and supported by tons of evidence!

[@MambaCool20]

Hello Friend, just read your bio, thank you for your time and content but we need more of it please it is great! 🙏🏾

[@aleksandrskagans4843]

First of all, thank you so much for detailed explanation. There are relatively new guidelines (2021) published by SCCM regarding sepsis. There are two recommendations on "Ventilation" section, regarding recruitment maneuvers. These are as follows : 53. For adults with sepsis-induced moderate-severe ARDS, we suggest using traditional recruitment maneuvers. 54. When using recruitment maneuvers, we recommend against using incremental PEEP titration/strategy. In rationale, there is explanation, that when the incremental PEEP recruitment studies are analyzed separately from studies utilizing traditional recruitment maneuvers, recruitment with incremental PEEP is associated with increased 28-day mortality RR, 1.12; 95% CI, 1.00−1.25), which justifies the strong recommendation against using incremental PEEP titration for recruitment. Taking all above mentioned, what is your opinion regarding recruitment type in sepsis patient?

[@RespiratoryReview]

Hi thanks for the great question. I’ve seen the guidelines and my opinion is that the recommendation against stepwise recruitment is a bit strong. Things I’d encourage you to look at would be the trials that used stepwise methods that were used to support the recommendation. There was no consistency in approach. Some had very large driving pressures while others kept driving pressure fixed while increasing PEEP. I think driving pressure drives mortality and it’s no different in the RM space. Ultimately I don’t think there’s strong enough evidence to prescribe a fixed RM tactic, which makes it hard to put into guidelines.

[@latestlatest4760]

Hi, in Staircase maneuver, how can we know if the PEEP has reach its maximum point (the top of the mountain in the scalar in your picture)?thx u

[@bonob0123]

SCCM recommending against use of incremental PEEP recruitment maneuvers for COVID patients. Only recommending traditional maneuvers (when appropriate). The meta analyses cited would apply to general ARDS patients not specific to COVID so applicable generally. Your thoughts?

[@RespiratoryReview]

Thanks for your comment. I'm aware of the SCCM recommendation regarding SRMs. I addressed RM in the video I posted summarizing the guidelines you're referring to. I personally don't feel they have enough evidence to support that position given the overall poor quality of the evidence for RMs in general. That being said, if planning to ventilate COVID patients by the SCCM guidelines then avoiding SRMs is the way to go.

[@AseenNidham]

Very nice vedio.. Thank you👍 Plz in next vedios can you make the written explanations more bigger😊will appreciate that sir Thank u again

[@mahmoudabdallah6023]

Thank you

[@user-bx8lf7mp4n]

THANK YOU

[@jennyd4421]

thanks...