Lung Volume Recruitment

Lung Volume Recruitment (LVR) is a way to fill a person’s lungs with more air than the person can usually take in when breathing naturally. LVR helps people who have:

• Diminished lung capacity due to muscle weakness.
• Restricted chest movement.

• Shallow breathing means less air is moving in and out of the lungs. When more air is taken into the lungs, the ability to cough, speak, and eat improves.
• Expanding the lungs helps move secretions, and it can lower the risk of illness.
• LVR helps keep the lungs open, which helps prevent infection and improves oxygenation (oxygen entering the lungs). When the lungs are open, it requires less effort to take a breath in. Imagine blowing up a new balloon for the first time. Once you get some air in, it gets much easier.

You perform LVR with a modified resuscitator, also known as a lung volume recruitment bag. Shaped like a bag or a balloon, a resuscitator is a simple device that delivers artificial breaths to people who cannot breathe adequately on their own.

To modify a resuscitator for LVR, you attach:

• A face mask
• A mouthpiece with an extension tube

This device is no longer suitable for resuscitation; it can ONLY be used for LVR.

• If the patient can't follow directions, coordinate holding their breath, or seal their mouth on the mouthpiece, you may need to use the mask instead.
• Ensure the person you’re providing LVR for has an adequate seal with the mask/mouthpiece so that air doesn’t leak out.
• Decide on the "signal" that their lungs are full or that they need to stop, such as raising a hand, looking up at the helper, nodding, etc.
• When squeezing the bag, squeeze over 1 second. Use enough air only to achieve chest rise or until they give you the "signal" to stop.
  • Applying too much pressure to the lungs can damage the small airways of the lungs, especially when using the mask.
• Start with small squeezes, 1 or 2 breaths at a time, until you get comfortable with it. It will take some teamwork and practice.

Breath Augmentation

1. Have the patient sit upright if possible. Reclining or lying flat is acceptable if they’re not slouching. 
2. Have them put their lips around the mouthpiece or place the mask over their nose and mouth. 
3. After fully exhaling the air from their lungs, have them begin a slow, steady, deep inhalation. 
4. While they're inhaling, squeeze the lung volume recruitment bag to give them small breaths in succession, one right after the other, until their lungs are full. 
5. Tell them to hold their breath as long as it’s comfortable. (Count to five if possible.) 
6. Exhale. 

That completes one cycle of breath augmentation LVR. 

Repeat three to five cycles of LVR if possible.

Breath Stacking

1. Have the patient sit upright if possible. Reclining or lying flat is acceptable if they’re not slouching. 
2. Have them put their lips around the mouthpiece or place the mask over their nose and mouth. 
3. As you squeeze the bag, have them take a breath in. They should not breathe out in between breaths. Give them 2-4 breaths, pausing only for a few seconds in between breaths. This is ‘stacking’ breaths on top of each other. 
4. When they feel full, have them hold their breath for a few seconds (count to five if possible), then breathe out (exhale). 

That completes one cycle of breath stacking LVR. 

Repeat three to five cycles of LVR if possible.

Use the QR code to watch the following LVR demonstrations:

• Mouthpiece breath stacking (with and without assistance)
• Mouthpiece breath augmentation (with and without assistance)
• Tracheostomy breath stacking (with and without assistance)
• Tracheostomy breath augmentation (with and without assistance)
• Mask breath staking
• Mask breath augmentation

• Do LVR two to three times per day. You can do it more often if you’d like.
• It’s best to do LVR before meals and at bedtime. When the stomach is empty, the breathing muscles have more room to move. If the patient has a G-tube, you can vent the G-tube of any air that may have entered the stomach during LVR.

• Wipe the bag gently. Don’t put it in water.
• Wash any used mouthpiece or mask in warm, soapy water once a day. Let them air dry completely.
• If it seems like the patient is not getting enough air, check for leaks or cracks in the equipment. You might need to replace a mask, mouthpiece, or extension tube.
• If any equipment needs to be replaced, contact your doctor.

Don’t do more than 5 cycles of LVR at a time. Pace yourself. 

Stop LVR and rest for a while if you experience:

• Dizziness.
• Chest pain.
• Nausea.

If you resume LVR and any of those symptoms continue, stop LVR and contact your doctor.