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Lung Recruitment and De-recruitment

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Mechanics of Breathing

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Abstract

Under normal conditions, a healthy lung is fully aerated, and no part will be airless or collapsed (or de-recruited). This is essential for optimum gas exchange, i.e., oxygenation of blood and removal of carbon dioxide (CO2) from the blood. Blood flow through an airless lung causes shunt, i.e., flow of blood that is not oxygenated and cannot eliminate CO2, resulting in hypoxemia and CO2 retention. De-recruitment can be seen in almost all patients during anesthesia and more so in acute lung injury (ALI) and as a complication in chronic obstructive lung disease. Airways close during a deep expiration and if lung volume is reduced by loss of respiratory muscle tone (anesthetics, sedatives, muscle relaxants), increased lung weight (edema in ALI), increased abdominal weight (obesity, abdominal edema), or increased gravitational forces (e.g., fighter pilots), alveolar gas will be adsorbed causing de-recruitment (atelectasis). Direct compression of lung may force gas out of the alveoli but may not be the most important mechanism. Reopening of the lung can be achieved by different recruitment maneuvers, balancing between the highest possible reopening and least possible damage to the lung, an issue that is not always met by full consensus. This makes lung recruitment a hot topic in research and clinic.

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Authors and Affiliations

  1. Department of Medical Sciences, Hedenstierna Laboratory, Uppsala University, University Hospital, entrance 40:2, Uppsala, S-75185, Sweden

    Göran Hedenstierna MD, PhD

  2. Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, University Hospital, Uppsala, S-75185, Sweden

    João B. Borges MD

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Correspondence to Göran Hedenstierna MD, PhD .

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  1. Politecnico di Milano, Milano, Italy

    Andrea Aliverti

  2. Politecnico di Milano, Milano, Italy

    Antonio Pedotti

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Hedenstierna, G., Borges, J.B. (2014). Lung Recruitment and De-recruitment. In: Aliverti, A., Pedotti, A. (eds) Mechanics of Breathing. Springer, Milano. https://doi.org/10.1007/978-88-470-5647-3_8

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