Comparison of Sequential lateral postural maneuver and Sustained hyperinflation maneuver as lung recruitment strategy in critically ill cirrhotic patients on mechanical ventilation A Randomised controlled trial

The dynamic process of reopening previously collapsed lung units through an intended transitory increase in trans pulmonary pressure is referred to as recruitment. • Recruitment maneuvers are methods for increasing the oxygenation by maintaining and reopening non-aerated areas of the lungs. 7 • Useful in

1. Improving gas exchange
2. Improving respiratory compliance • Patients receiving positive pressure ventilation are prone to develop atelectasis and need periodic recruitment. • In cirrhotic patients on ventilator, following are the reasons for developing atelectasis. • Ascites that contributes to the loss of aeration in caudal and dependent lung segments leading to atelectasis and airway closure. • Thoracic compliance is decreased by respiratory anomalies including hepatic hydrothorax and pleural effusions (chest wall edema). • A relative immunocompromised status combined with an overactive inflammatory response increases the risk of pneumonia and acute lung damage.