Atelectasis and Derecruitment

  • Maximizing V/Q matching:
    • By preventing atelectasis:
      • Is a key principle in the management of:
        • Respiratory failure
      • Alveolar derecruitment, or atelectasis:
        • Leads to the creation of shunts
      • Atelectasis has multiple detrimental effects in ventilated patients:
        • First:
          • Atelectasis decreases the surface area for gas exchange
        • Atelectasis on a large scale:
          • Is derecruitment
        • Derecruitment is compounded by:
          • Excessive lung weight:
            • Such as with pulmonary edema
          • Chest wall weight:
            • As with morbid obesity
          • Abdominal contents and distention:
            • As with small bowel obstructions)
          • Cardiac compresses:
            • As with pericardial effusion
          • The addition of sedation and paralysis:
            • To positive pressure ventilation:
              • Can further augment this derecruitment
    • This diagram reflects the pressures leading to compression of the lungs when lying a patient supine:
      • The weight of the heart, the weight of the chest wall, the weight of the abdominal contents, and the weight of the lungs themselves

#Arrangoiz #Teacher #Surgeon

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