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 Technologies

P/V Tool®. Assess recruitability and perform recruitment maneuvers

Yellow balloons in different stages to represent different lung conditions

Recruiter or non-recruiter? A diagnostic tool

The Protective Ventilation Tool (P/V Tool) performs a respiratory mechanics maneuver that records a quasi-static pressure-volume curve, which describes the mechanical behavior of the lungs and chest wall during inflation and deflation.

This method can be used to assess lung recruitability and determine the recruitment strategy to apply (Demory D, Arnal JM, Wysocki M, et al. Recruitability of the lung estimated by the pressure volume curve hysteresis in ARDS patients. Intensive Care Med. 2008;34(11):2019-2025. doi:10.1007/s00134-008-1167-81​).

Pressure and volume curves with the P/V Tool

What is the right strategy? Use a recruitment tool

The P/V Tool can also be used to perform a sustained inflation recruitment maneuver and measure the increase in lung volume (Lung recruitment maneuvers whitepaper2​​). You can set the pressure ramp, maximum pressure, duration, and PEEP level after the maneuver to suit the individual patient.

This is particularly helpful in ARDS patients, as selecting an appropriate lung‑recruitment strategy and the correct PEEP setting as an anti‑derecruiting force are critical for this patient group (Gattinoni L, Caironi P, Cressoni M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;354(17):1775-1786. doi:10.1056/NEJMoa0520523​).

How to perform a recruitment maneuver with the P/V Tool (article)
NutriVent multifunction nasogastric catheter

Can it improve your ventilaton strategy? A lung-protection tool

In combination with esophageal pressure measurement, the P/V Tool can give you a clearer understanding of the lung and chest-wall mechanics.

This enables you to apply a lung-protective ventilation strategy by titrating the PEEP level (Caironi P, Cressoni M, Chiumello D, et al. Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2010;181(6):578-586. doi:10.1164/rccm.200905-0787OC4​) and optimizing the parameters for the recruitment maneuver, then subsequently optimizing driving pressure and tidal volume.

User interface of the P/V Tool User interface of the P/V Tool

How does it work? P/V Tool principles

You can perform P/V Tool maneuvers without making any changes to the mode or ventilator settings. Normal ventilation can be resumed at any time. The P/V Tool records the pressure-volume relation of the lungs at low-flow conditions (2–5 cmH2O/s).

The breathing circuit is pressurized linearly to the operator-set pressure target. When the pressure reaches the target, pressure is reduced back to the starting pressure.

Ken Hargett Camille Neville

Customer voices

We use the P/V Tool to determine initial PEEP settings on almost all ventilator patients once they have been sedated for the intubation. We also use the recruitment portion of the P/V Tool a lot, particularly for patients who are having repeated atelectasis.

Ken Hargett

Director Respiratory Care (until 2019)
Methodist Hospital, Houston (TX), USA

Customer voices

Our respiratory therapists use the P/V Tool as soon as they put the patient on the ventilator to obtain optimum PEEP. The therapists find it very helpful, especially on the sicker patients.

Camille Neville

Clinical Educator for the Respiratory Department
Florida Hospital, Orlando, USA

Statistic graphic: Amato MB. Nengl J Med. 1998 Feb 5;338(6):347-54

Do you have proof? A look at the evidence

Lung protection is one of the major objectives when mechanically ventilating a patient.

In terms of changes in oxygenation, recruited volume, or hyperinflation, lung characteristics and morphology are strong predictors of the response to PEEP settings or recruitment maneuvers (Constantin JM, Futier E, Cherprenet AL, et al. A recruitment maneuver increases oxygenation after intubation of hypoxemic intensive care unit patients: a randomized controlled study. Crit Care. 2010;14(2):R76. doi:10.1186/cc89895​).

A personalized strategy may decrease mortality in moderate-to-severe-ARDS patients if lung morphology is correctly assessed (Constantin JM, Jabaudon M, Lefrant JY, et al. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial. Lancet Respir Med. 2019;7(10):870-880. doi:10.1016/S2213-2600(19)30138-96​). Lung protection not only reduces mortality in ARDS patients (Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. 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):1301-1308. doi:10.1056/NEJM2000050434218017​), but also reduces the risk of secondary ARDS in normal-lung patients (Determann RM, Royakkers A, Wolthuis EK, et al. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care. 2010;14(1):R1. doi:10.1186/cc82308​) and of complications in post-surgery patients (Costa Leme A, Hajjar LA, Volpe MS, et al. Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications: A Randomized Clinical Trial. JAMA. 2017;317(14):1422-1432. doi:10.1001/jama.2017.22979​, Hu MC, Yang YL, Chen TT, Chen JT, Tiong TY, Tam KW. Recruitment maneuvers in patients undergoing thoracic surgery: a meta-analysis. Gen Thorac Cardiovasc Surg. 2021;69(12):1553-1559. doi:10.1007/s11748-021-01673-7 10​) .

Graphic illustration: student holding certificate in his hand

Good to know! P/V Tool training resources

Start learning here
Black arrows pointing in to blue circle with writing To the point

To the point Get the lowdown on milestones in medical research

Find out more about the quasi-static PV curve for assessing recruitability at the bedside! It’s just one of the articles in our collection that brings you the key facts and findings from watershed papers in an easy‑to‑digest format.

Get to the point

Availability

The P/V Tool is available as an option on the HAMILTON-C3/C6 and HAMILTON-G5, and is a standard feature on the HAMILTON-S1.

HAMILTON-C6

HAMILTON-C6
HAMILTON-C3

HAMILTON-C3

For more information

Document
P/V Tool brochure
English | 4.79 MB | ELO20240211N.00
Document
P/V Tool® Pro Quick Reference Card
English | 0.58 MB | 10073162.01
Document
P/V Tool® Pro User guide User Guide
English | 2.13 MB | 10067117.01
Article
Pressure target increase in P/V Tool® vs. continuous low flow
Document
Lung recruitment bibliography
English | 1.78 MB | ELO20160113S.07
Show more

References

  1. 1. Demory D, Arnal JM, Wysocki M, et al. Recruitability of the lung estimated by the pressure volume curve hysteresis in ARDS patients. Intensive Care Med. 2008;34(11):2019-2025. doi:10.1007/s00134-008-1167-8
  2. 2. ELO20160409S.01
  3. 3. Gattinoni L, Caironi P, Cressoni M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;354(17):1775-1786. doi:10.1056/NEJMoa052052
  4. 4. Caironi P, Cressoni M, Chiumello D, et al. Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2010;181(6):578-586. doi:10.1164/rccm.200905-0787OC
  5. 5. Constantin JM, Futier E, Cherprenet AL, et al. A recruitment maneuver increases oxygenation after intubation of hypoxemic intensive care unit patients: a randomized controlled study. Crit Care. 2010;14(2):R76. doi:10.1186/cc8989

 

  1. 6. Constantin JM, Jabaudon M, Lefrant JY, et al. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial. Lancet Respir Med. 2019;7(10):870-880. doi:10.1016/S2213-2600(19)30138-9