Calculation of recruitment -to-inflation ratio in patients with acute respiratory distress syndrome
Abstract
Titrating positive end-expiratory pressure in patients with acute respiratory distress syndrome (ARDS) is controversial. Assessment of the potential for lung recruitment is difficult to implement in daily practice and requires additional equipment. In 2019, the recruitment-to-inflation (R/I) ratio was validated as a method to assess lung recruitment in patients with ARDS. It is a simple and fast method to be performed at the bedside.
This study describes the procedure to obtain the R/I ratio, detailing the maneuvers and necessary calculations.
References
Tobin MJ. Principles & Practices of Mechanical Ventilation. 3rd ed. Chicago: Mc Graw Hill; 2013.
Papazian L, Aubron C, Brochard L, Chiche JD, Combes A, Dreyfuss D et al. Formal guidelines: management of acute respiratory distress syndrome. Ann Intensive Care. 2019;9(1):69.
Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301-8.
Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2004;351(4):327-36.
Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM et al. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299(6):637-45.
Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299(6):646-55.
Sahetya SK, Goligher EC, Brower RG. Fifty Years of Research in ARDS. Setting Positive End-Expiratory Pressure in Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2017;195(11):1429-1438. Erratum in: Am J Respir Crit Care Med. 2018;197(5):684-685.
Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;354(17):1775-86.
Chen L, Del Sorbo L, Grieco DL, Junhasavasdikul D, Rittayamai N, Soliman I et al. Potential for Lung Recruitment Estimated by the Recruitment-to-Inflation Ratio in Acute Respiratory Distress Syndrome. A Clinical Trial. Am J Respir Crit Care Med. 2020;201(2):178-187.
Chen L, Del Sorbo L, Grieco DL, Shklar O, Junhasavasdikul D, Telias I et al. Airway Closure in Acute Respiratory Distress Syndrome: An Underestimated and Misinterpreted Phenomenon. Am J Respir Crit Care Med. 2018;197(1):132-136.
Hess DR. Respiratory mechanics in mechanically ventilated patients. Respir Care. 2014;59(11):1773-94.
