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Concept: Maneuver


Recruitment maneuvers (RMs), which aim to ventilate the collaborated alveolus by temporarily increasing the transpulmonary pressure, have positive effects in relation to respiration, mainly oxygenation. Although many studies have defined the pressure values used during RM and the application period, our knowledge of the effects of different oxygen concentrations is limited. In this study, we aimed to determine the effects of different oxygen concentrations during RM on the arterial oxygenation and respiration mechanics in laparoscopic cases.

Concepts: Oxygen, Surgery, Anesthesia, General anaesthesia, Laparoscopic surgery, Laparoscopy, Respiration, Maneuver


The injurious effects of alveolar overdistention are well accepted, and there is little debate regarding the importance of pressure and volume limitation during mechanical ventilation. The role of recruitment maneuvers is more controversial. Alveolar recruitment is desirable if it can be achieved, but the potential for recruitment is variable among patients with ARDS. A stepwise recruitment maneuver, similar to an incremental PEEP titration, is favored over sustained inflation recruitment maneuvers. Many approaches to PEEP titration have been proposed, and the best method to choose the most appropriate level for an individual patient is unclear. A PEEP level should be selected that balances alveolar recruitment against overdistention. The easiest approach to select PEEP might be according to the severity of the disease: 5-10 cm H2O PEEP in mild ARDS, 10-15 cm H2O PEEP in moderate ARDS, and 15-20 cm H2O PEEP in severe ARDS. Recruitment maneuvers and PEEP should be used within the context of lung protection and not just as a means of improving oxygenation.

Concepts: Pulmonology, Patient, Pneumonia, Acute respiratory distress syndrome, According to Jim, Selection, Maneuver, Maneuver warfare


Patients who increase stoke volume or cardiac index more than 10 or 15% after a fluid challenge are usually considered fluid responders. Assessment of fluid responsiveness prior to volume expansion is critical to avoid fluid overload, which has been associated with poor outcomes. Maneuvers to assess fluid responsiveness are well established in mechanically ventilated patients; however, few studies evaluated maneuvers to predict fluid responsiveness in spontaneously breathing patients. Our objective was to perform a systematic review of literature addressing the available methods to assess fluid responsiveness in spontaneously breathing patients. Studies were identified through electronic literature search of PubMed from 01/08/2009 to 01/08/2016 by two independent authors. No restrictions on language were adopted. Quality of included studies was evaluated with Quality Assessment of Diagnostic Accuracy Studies tool. Our search strategy identified 537 studies, and 9 studies were added through manual search. Of those, 15 studies (12 intensive care unit patients; 1 emergency department patients; 1 intensive care unit and emergency department patients; 1 operating room) were included in this analysis. In total, 649 spontaneously breathing patients were assessed for fluid responsiveness. Of those, 340 (52%) were deemed fluid responsive. Pulse pressure variation during the Valsalva maneuver (∆PPV) of 52% (AUC ± SD: 0.98 ± 0.03) and passive leg raising-induced change in stroke volume (∆SV-PLR) > 13% (AUC ± SD: 0.96 ± 0.03) showed the highest accuracy to predict fluid responsiveness in spontaneously breathing patients. Our systematic review indicates that regardless of the limitations of each maneuver, fluid responsiveness can be assessed in spontaneously breathing patients. Further well-designed studies, with adequate simple size and power, are necessary to confirm the real accuracy of the different methods used to assess fluid responsiveness in this population of patients.

Concepts: Hospital, Evaluation, Cardiology, Assessment, Psychometrics, Responsiveness, Valsalva maneuver, Maneuver


Atelectasis is a common finding in mechanically ventilated children with healthy lungs. This lung collapse cannot be overcome using standard levels of positive end-expiratory pressure (PEEP) and thus for only individualized lung recruitment maneuvers lead to satisfactory therapeutic results. In this short communication, we demonstrate by lung ultrasound images (LUS) the effect of a postural recruitment maneuver (P-RM, i.e., a ventilatory strategy aimed at reaerating atelectasis by changing body position under constant ventilation).

Concepts: Pulmonology, Lung, Pneumothorax, Maneuver


Objective To quantify the effects of 2 swallowing maneuvers used in dysphagia rehabilitation-the Mendelsohn maneuver and effortful swallowing-on pharyngoesophageal function with novel, objective pressure-flow analysis. Study Design Evaluation of intervention effects in a healthy control cohort. Setting A pharyngoesophageal motility research laboratory in a tertiary education facility. Subjects Twelve young healthy subjects (9 women, 28.6 ± 7.9 years) from the general public, without swallowing impairment, volunteered to participate in this study. Methods Surface electromyography from the floor-of-mouth musculature and high-resolution impedance manometry-based pressure flow analysis were used to assess floor-of-mouth activation and pharyngoesophageal motility, respectively. Subjects each performed 10 noneffortful control swallows, Mendelsohn maneuver swallows, and effortful swallows, with a 5-mL viscous bolus. Repeated measures analyses of variance was used to compare outcome measures across conditions. Results Effortful and Mendelsohn swallows generated greater floor-of-mouth contraction ( P = .001) and pharyngeal pressure ( P < .0001) when compared with control swallows. There were no changes at the level of the upper esophageal sphincter, except for a faster opening to maximal diameter during maneuver swallows ( P = .01). The proximal esophageal contractile integral was reduced during Mendelsohn swallows ( P = .001). Conclusion Effortful and Mendelsohn maneuver swallows significantly alter the pharyngoesophageal pressure profile. Faster opening of the upper esophageal sphincter may facilitate bolus transfer during maneuver swallows; however, reduced proximal esophageal contractility during Mendelsohn maneuver swallows may impair bolus flow and aggravate dysphagic symptoms.

Concepts: Scientific method, Electromyography, Gastroesophageal reflux disease, Esophagus, Achalasia, Tertiary education, Swallow, Maneuver


The prevalence of benign paroxysmal positional vertigo (BPPV) is higher in people with type 2 diabetes (DM). The impact of DM on mobility, balance, and management of BPPV is unknown. This prospective study compared symptom severity, mobility and balance before and after the canalith repositioning maneuver (CRM) in people with posterior canal BPPV canalithiasis, with and without DM.

Concepts: Diabetes mellitus type 2, Diabetes mellitus, Benign paroxysmal positional vertigo, Maneuver, Maneuver warfare


A simple and low cost tongue manoeuvre to obtain better panoramic radiographs.

Concepts: Maneuver, Maneuver warfare


This study examined the anticipation and visual behavior of elite Rugby League (RL) player’s during two different evasion maneuvers (side- and split-step). Participants (N = 48) included elite RL players (n = 38) and controls (n = 10). Each participant watched videos consisting of side- and split-steps with anticipation of movement and eye behavior measured. No significant differences between the groups or evasion maneuver were found. The split-step was significantly harder to predict. Elite players appeared to spend more time viewing the torso and mid-region of the body compared to the controls.

Concepts: Participation, Players, Player, Rugby league, Maneuver


To make a comprehensive analysis with a variety of diagnostic maneuvers is conducive to the correct diagnosis and classification of BPPV.

Concepts: Scientific method, Diagnosis, Greek loanwords, Benign paroxysmal positional vertigo, Maneuver, Maneuver warfare


The purpose of this study was to demonstrate the feasibility of a device for monitoring pressure relief maneuvers and physical activity for wheelchair users. The device counts the number of wheel-pushes based on wheelchair acceleration and measures pressure relief maneuvers using a seat-sensor consisting of three force sensing resistors. To establish the feasibility of the seat-sensor for the detection of pressure relief maneuvers, ten wheelchair users and ten non-disabled controls completed a series of wheelchair depression raises, forward trunk leans, and lateral trunk leans. The seat-sensor was placed underneath the user’s own seat cushion. To establish the feasibility of wheel-push counting, ten full-time wheelchair users navigated a flat 50 m outdoor track and a 100 m outdoor obstacle course during self-propulsion (e.g., wheel-pushes) and during assisted-propulsion (e.g., someone else pushing the wheelchair, no wheel-pushes). Of the 240 performed pressure relief, 225 were properly classified by the seat-sensor (accuracy: 94%, sensitivity: 96%, specificity: 80%). All four types of maneuvers had accuracy above 94%. Sensitivity was highest for depression raises (98%) and lowest for front lean maneuvers (80%). The wheelchair activity monitor measured 2112 pushes during the self-propulsion trials compared to 2162 pushes measured with the instrumented push-rim (97.7%). During assisted-propulsion trials there were 477 incorrectly identified pushes (8.0 per trial).

Concepts: Measurement, Sensitivity and specificity, Wheelchair, Maneuver