scholarly journals Alveolar Recruitment Maneuvers Under General Anesthesia: A Systematic Review of the Literature

2014 ◽  
Vol 60 (4) ◽  
pp. 609-620 ◽  
Author(s):  
B. L. Hartland ◽  
T. J. Newell ◽  
N. Damico
Keyword(s):  
Systematic Review ◽  
General Anesthesia ◽  
Alveolar Recruitment ◽  
Review Of The Literature ◽  
Recruitment Maneuvers

scholarly journals The Effect of Positive End Expiratory Pressure (PEEP) with Recruitment Maneuvers on Atelectasis in Obese Patients Undergoing Abdominal Surgery: A Systematic Review

2019 ◽  
Author(s):  
Jon Cerami
Keyword(s):  
Systematic Review ◽  
Abdominal Surgery ◽  
General Anesthesia ◽  
Surgical Procedures ◽  
Alveolar Recruitment ◽  
Obese Patients ◽  
Arterial Oxygenation ◽  
Positive End Expiratory Pressure ◽  
Recruitment Maneuvers ◽  
Obese Population

General anesthesia has a profound effect on respiratory dynamics in the obese population. Obesity can contribute to a decreased functional residual capacity, reduced lung volumes, and an increased closing capacity. Positioning and procedural requirements can further complicate the respiratory status of the obese patient. Surgical procedures in the obese population have an increased risk for the formation of atelectasis. Ventilation can be compromised due to atelectatic lung tissue and may result in post operative complications such as pneumonia, acute respiratory distress, hypoxia, a prolonged hospital stay, and the need for prolonged mechanical ventilation. Positive end-expiratory pressure (PEEP) is utilized in the operating room to increase arterial oxygenation, prevent airway collapse and expand alveoli during each breath. Alveolar recruitment maneuvers can be supplementary throughout surgical procedures to recruit and restore atelectatic lung tissue and prevent further formation of atelectasis. The purpose of this systematic review was to evaluate the effect of PEEP with recruitment maneuvers in obese patients undergoing abdominal surgery with general anesthesia. The theoretical framework that guided this systematic review was the Preferred Reporting Items for Systematic Review and Meta- Analysis (PRISMA) Statement. Randomized control trials included in this systematic review were appraised using the Critical Appraisal Skills Programme (CASP) to evaluate reliability. Alveolar recruitment maneuvers increase lung compliance, arterial oxygenation, and decrease complications associated with atelectasis formation. The use of PEEP with alveolar recruitment maneuvers should be employed for obese patients that undergo abdominal surgery with general anesthesia.

scholarly journals Efficacy of Alveolar Recruitment Maneuvers in the Adult Obese Patient Undergoing General Anesthesia: A Systematic Review of the Literature

2018 ◽  
Author(s):  
Joseph Banks
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
General Anesthesia ◽  
Obese Patient ◽  
Perioperative Period ◽  
Lung Compliance ◽  
Alveolar Recruitment ◽  
Respiratory Physiology ◽  
Arterial Oxygen ◽  
Recruitment Maneuvers

There are many pathophysiologic health effects associated with obesity, and the effects on normal respiratory physiology can be profound. The presence of increased adipose tissue can limit a patient’s functional residual capacity, reduce end expiratory lung volumes, and increase small airway closure. When exposed to general anesthesia with mechanical ventilation these physiologic changes can increase atelectasis development and increase the likelihood of ventilation-perfusion mismatching. Alveolar recruitment maneuvers are brief applications of positive airway pressure that are employed to recruit alveoli that have already collapsed and prevent new atelectasis formation. The purpose of this systematic review was to determine if the use of alveolar recruitment maneuvers are a safe and effective treatment strategy for managing the adult obese patient requiring general anesthesia with mechanical ventilation. The theoretical framework that guided this systematic review was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Randomized control trials that utilized alveolar recruitment maneuvers in adult obese patients were reviewed and appraised for inclusion in this systematic review. It was determined that alveolar recruitment maneuvers are a safe and effective strategy for minimizing atelectasis development in the adult obese patient undergoing general anesthesia. Alveolar recruitment maneuvers were associated with an improved intraoperative oxygenation, a decreased alveolar-arterial oxygen concentration gradient, and improved lung compliance. Furthermore, alveolar recruitment maneuver use demonstrated a decrease in atelectasis development measured via computed tomography and radiograph imaging. Application of these maneuvers in the obese patient during the perioperative period can improve ventilation-perfusion matching and decrease respiratory complications associated with atelectasis development.

scholarly journals Evaluation of alveolar recruitment maneuver on respiratory resistance during general anesthesia: a prospective observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Junko Nakahira ◽  
Shoko Nakano ◽  
Toshiaki Minami
Keyword(s):  
Mechanical Ventilation ◽  
General Anesthesia ◽  
Recruitment Maneuver ◽  
Peak Inspiratory Pressure ◽  
Alveolar Recruitment ◽  
Trial Registration ◽  
Inspiratory Pressure ◽  
Forced Oscillation Technique ◽  
Respiratory Resistance ◽  
Recruitment Maneuvers

Abstract Background Alveolar recruitment maneuvers enable easily reopening nonaerated lung regions via a transient elevation in transpulmonary pressure. To evaluate the effect of these maneuvers on respiratory resistance, we used an oscillatory technique during mechanical ventilation. This study was conducted to assess the effect of the alveolar recruitment maneuvers on respiratory resistance under routine anesthesia. We hypothesized that respiratory resistance at 5 Hz (R5) after the maneuver would be decreased after the lung aeration. Methods After receiving the ethics committee’s approval, we enrolled 33 patients who were classified with an American Society of Anesthesiologists physical status of 1, 2 or 3 and were undergoing general anesthesia for transurethral resection of a bladder tumor within a 12-month period from 2017 to 2018. The recruitment maneuver was performed 30 min after endotracheal intubation. The maneuver consisted of sustained manual inflation of the anesthesia reservoir bag to a peak inspiratory pressure of 40 cmH2O for 15 s, including 5 s of gradually increasing the peak inspiratory pressure. Respiratory resistance was measured using the forced oscillation technique before and after the maneuver, and the mean R5 was calculated during the expiratory phase. The respiratory resistance and ventilator parameter results were analyzed using paired Student’s t-tests, and p < 0.05 was considered statistically significant. Results We analyzed 31 patients (25 men and 6 women). R5 was 7.3 ± 1.6 cmH2O/L/sec before the recruitment maneuver during mechanical ventilation and was significantly decreased to 6.4 ± 1.7 cmH2O/L/sec after the maneuver. Peak inspiratory pressure and plateau pressure were significantly decreased, and pulmonary compliance was increased, although the values were not clinically relevant. Conclusion The recruitment maneuver decreased respiratory resistance and increased lung compliance during mechanical ventilation. Trial registration Name of registry: Japan Medical Association Center for Clinical Trials. Trial registration number: reference JMA-IIA00136. Date of registration: 2 September 2013. URL of trial registry record: https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRE02_04/JMACTRE02_04.aspx?kbn=3&seqno=3582

Telepractice for Adult Speech-Language Pathology Services: A Systematic Review

2020 ◽  
Vol 5 (1) ◽  
pp. 326-338 ◽  
Author(s):  
Kristen Weidner ◽  
Joneen Lowman
Keyword(s):  
Systematic Review ◽  
Primary Progressive Aphasia ◽  
Future Research ◽  
Service Delivery Model ◽  
Speech Language Pathology ◽  
Review Of The Literature ◽  
Research Designs ◽  
Assessment And Treatment ◽  
Language Pathology ◽  
Screening Assessment

Purpose We conducted a systematic review of the literature regarding adult telepractice services (screening, assessment, and treatment) from approximately 2014 to 2019. Method Thirty-one relevant studies were identified from a literature search, assessed for quality, and reported. Results Included studies illustrated feasibility, efficacy, diagnostic accuracy, and noninferiority of various speech-language pathology services across adult populations, including chronic aphasia, Parkinson's disease, dysphagia, and primary progressive aphasia. Technical aspects of the equipment and software used to deliver services were discussed. Some general themes were noted as areas for future research. Conclusion Overall, results of the review continue to support the use of telepractice as an appropriate service delivery model in speech-language pathology for adults. Strong research designs, including experimental control, across multiple well-described settings are still needed to definitively determine effectiveness of telepractice services.

Sign in / Sign up

Export Citation Format

Share Document