Lung volume recruitment

In this chapter we will discuss recommendations from the hterature regarding dec-aruiulation as well as our personal clinical experience. We will comment on the pathophysiology of ventilator dependence, the determination of candidates for weaning from ventilation and tracheostomy, and a stepwise approach to decannulation. Lastly, we will discuss the choices of noninvasive ventilatory supports and techniques that clinicians may utilize, such as lung volume recruitment (LVR), assisted coughing and mechanical airway clearance. 

Figure 2 Lung volume recruitment. Flow volume loops. The MIC is maintained (higher expired flow) in a patient with ALS over a period of one year despite complete loss of measurable, spontaneous (lower flow) respiratory muscle function. Abbreviations MIC, maximum insufflation capacity ALS, amyotrophic lateral sclerosis.

Figure 3 (A) An LVR using a resuscitation bag in spinal cord injury around tracheostomy tube. (B) Ventilation trial with volume ventilation around a corked tracheostomy tube. Abbreviation LVR, lung volume recruitment.

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