Lung recruitment in mechanical ventilation

1 . A ventilation system, comprising:

a breathing apparatus for providing mechanical ventilation to a patient, the breathing apparatus being configured to perform, at a first point in time,

an automated full recruitment manoeuvre, FRM, comprising a recruitment phase, a PEEP titration phase, and a re-recruitment phase, the FRM being performed based on preset FRM settings, and, at a second and later point in time following a period of baseline ventilation,

an automated quick recruitment manoeuvre, QRM, comprising a recruitment phase but no PEEP titration phase or re-recruitment phase, the QRM being performed based on preset QRM settings, the breathing apparatus being configured to initiate at least one QRM setting based on a result of the FRM, wherein the at least one QRM setting comprises a PEEP max setting for setting a maximum PEEP for the recruitment phase of the QRM, in which the maximum PEEP setting is initiated from an optimal PEEP or an alveolar opening pressure of the patient determined during the FRM, and

wherein the breathing apparatus is configured to determine a time elapsed since the FRM was performed, and to initiate the at least one QRM setting from the result of the FRM only if the time elapsed is less than a predefined threshold value.

2 . The ventilation system of claim 1 , wherein the at least one QRM setting further comprises a maximum peak inspiratory pressure, PIP, setting to be used during the recruitment phase of the QRM, which maximum PIP setting is initiated from an optimal PEEP and/or an alveolar opening pressure of the patient, determined during the FRM.

3 . The ventilation system of claim 1 , wherein the breathing apparatus is configured to initiate the at least one QRM setting based on a corresponding FRM setting used for the FRM, and to initiate at least one other QRM setting based on the result of the FRM.

4 . The ventilation system of claim 1 , wherein the at least one QRM setting further comprises QRM recruitment settings defining a pressure trajectory for PIP (H) and a pressure trajectory for PEEP (I) to be followed during the recruitment phase of the QRM, which the QRM recruitment settings are initiated based on corresponding FRM settings defining a pressure trajectory for PIP (A) and a pressure trajectory for PEEP (B) used for the FRM.

5 . The ventilation system of claim 1 , wherein the breathing apparatus is configured to monitor at least one parameter being indicative of collapse of alveoli to initiate the at least one QRM setting from settings and/or results of the FRM based on a change of the parameter or if a predefined threshold value of the parameter is reached or to initiate the at least one QRM setting from settings and/or results of the FRM if a certain time has elapsed since the FRM last performed.

6 . The ventilation system of claim 1 , wherein the at least one QRM setting is any of, or any combination of:

a PIP max setting for setting a maximum PIP for the recruitment phase of the QRM, which the PIP max setting is initiated from any of, or any combination of, a corresponding PIP max setting set for the FRM, an alveolar opening pressure determined during the FRM, and an optimal PEEP determined during the FRM;

a PEEP incr/step setting for setting an incremental increase in PEEP between consecutive PEEP steps of the recruitment phase of the QRM, which the PEEP incr/step setting is initiated from a corresponding PEEP incr/step setting set for the FRM;

a recruitment rate setting for setting a respiratory rate for the recruitment phase of the QRM, which the recruitment rate setting is initiated from a corresponding recruitment rate setting set for the FRM;

a breaths/step setting for setting a number of breaths on each PEEP step of the recruitment phase of the QRM, which the breaths/step setting is initiated from a corresponding breaths/step setting set for the FRM;

a breaths at PEEP max setting for setting a number of breaths at the maximum PEEP level of the recruitment phase of the QRM, which the Breaths at PEEP max setting is initiated from a corresponding breaths at PEEP max setting set for the FRM; and

a post-RM PEEP setting for setting a PEEP for a period of post-RM ventilation following the QRM.

7 . A method for a lung recruitment in a mechanically ventilated patient, comprising the steps of:

performing, at a first point in time, an automated full recruitment manoeuvre, FRM, comprising a recruitment phase, a PEEP titration phase, and a re-recruitment phase, the FRM being performed based on preset FRM settings, and

performing, at a second and later point in time following a period of baseline ventilation, an automated quick recruitment manoeuvre, QRM, comprising a recruitment phase but no PEEP titration phase or re-recruitment phase, the QRM being performed based on preset QRM settings,

wherein at least one of the QRM settings is initiated based on a result of the FRM, wherein the at least one QRM setting comprises a PEEP max setting for setting a maximum PEEP for the recruitment phase of the QRM, in which the maximum PEEP setting is initiated from an optimal PEEP or an alveolar opening pressure of the patient determined during the FRM,

and wherein the breathing apparatus is configured to determine a time elapsed since the FRM was performed, and to initiate the at least one QRM setting from the result of the FRM only if the time elapsed is less than a predefined threshold value.

8 . The method of claim 7 , wherein the at least one QRM setting further comprises a maximum PIP setting to be used during the recruitment phase of the QRM, which maximum PIP setting is initiated from an optimal PEEP and/or an alveolar opening pressure of the patient, determined during the FRM.

9 . The method of claim 7 , wherein the at least one QRM setting is initiated based on a corresponding FRM setting used for the FRM, and at least one other QRM setting is initiated based on the result of the FRM.

10 . The method of claim 7 , wherein the at least one QRM setting further comprises QRM recruitment settings defining a pressure trajectory for PIP (H) and a pressure trajectory for PEEP (I) to be followed during the QRM recruitment phase, which the QRM recruitment settings are initiated based on corresponding FRM settings defining a pressure trajectory for PIP (A) and a pressure trajectory for PEEP (B) used for the FRM.

11 . A computer program for a lung recruitment in a mechanically ventilated patient, the computer program comprises computer-readable instruction which, when executed by a computer of a ventilation system comprising a breathing apparatus, causes the ventilation system to perform the method of claim 6 .