You have successfully recruited your patient’s pulmonary alveoli. Now, will the alveoli STAY patent so that you can extubate your patient with great success? Go to minimal pulmonary support and continue to assess … if your patient’s tidal volume trend stays neutral or increases, you will likely have a successful extinction.
How to enact Alveolar Recruitment Therapy (ART).
It becomes glaring obvious what needs to be done.
The RV needs to be decongested.
The LV needs to be refilled.
We can do this many ways :
> give a pulmonary vasodilator –
via inhalational route : nitric oxide, Iloprost.
via intravenous route : milrinone (we’ll discuss later).
> oxygenate the pulmonary interstitum properly (increase FiO2).
> oxygenate the pulmonary interstitium and reverse HPV via alveolar recruitment maneuver (ARM).