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Critical Care

, 12:R50

First Online: 16 April 2008Received: 08 February 2008Revised: 31 March 2008Accepted: 16 April 2008

Abstract

IntroductionAlveolar derecruitment may occur during low tidal volume ventilation and may be prevented by recruitment maneuvers RMs. The aim of this study was to compare two RMs in acute respiratory distress syndrome ARDS patients.

MethodsNineteen patients with ARDS and protective ventilation were included in a randomized crossover study. Both RMs were applied in each patient, beginning with either continuous positive airway pressure CPAP with 40 cm H2O for 40 seconds or extended sigh eSigh consisting of a positive end-expiratory pressure maintained at 10 cm H2O above the lower inflection point of the pressure-volume curve for 15 minutes. Recruited volume, arterial partial pressure of oxygen-fraction of inspired oxygen PaO2-FiO2, and hemodynamic parameters were recorded before baseline and 5 and 60 minutes after RM. All patients had a lung computed tomography CT scan before study inclusion.

ResultsBefore RM, PaO2-FiO2 was 151 ± 61 mm Hg. Both RMs increased oxygenation, but the increase in PaO2-FiO2 was significantly higher with eSigh than CPAP at 5 minutes 73% ± 25% versus 44% ± 28%; P < 0.001 and 60 minutes 68% ± 23% versus 35% ± 22%; P < 0.001. Only eSigh significantly increased recruited volume at 5 and 60 minutes 21% ± 22% and 21% ± 25%; P = 0.0003 and P = 0.001, respectively. The only difference between responders and non-responders was CT lung morphology. Eleven patients were considered as recruiters with eSigh 10 with diffuse loss of aeration and 6 with CPAP 5 with diffuse loss of aeration. During CPAP, 2 patients needed interruption of RM due to a drop in systolic arterial pressure.

ConclusionBoth RMs effectively increase oxygenation, but CPAP failed to increase recruited volume. When the lung is recruited with an eSigh adapted for each patient, alveolar recruitment and oxygenation are superior to those observed with CPAP.

AbbreviationsALIALI = acute lung injury

ARDSARDS = acute respiratory distress syndrome

CPAPCPAP = continuous positive airway pressure

DescriptionCT = computed tomography

EELVEELV = end-expiratory lung volume

eSigheSigh = extended sigh

FiO2FiO2 = fraction of inspired oxygen

HUHU = Hounsfield units

LIPLIP = lower inflection point

PaCO2PaCO2 = arterial partial pressure of carbon dioxide

PaO2PaO2 = arterial partial pressure of oxygen

PEEPPEEP = positive end-expiratory pressure

PmaxPmax = peak inspiratory pressure

PplatPplat = plateau pressure

P-VP-V = pressure-volume

RMRM = recruitment maneuver

RVRV = recruited volume

SpO2SpO2 = oxygen saturation as measured by pulse oximetry

UIPUIP = upper inflection point

VTVT = tidal volume

ZEEPZEEP = zero end-expiratory pressure.

Electronic supplementary materialThe online version of this article doi:10.1186-cc6869 contains supplementary material, which is available to authorized users.

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Autor: Jean-Michel Constantin - Samir Jaber - Emmanuel Futier - Sophie Cayot-Constantin - Myriam Verny-Pic - Boris Jung - Anne Bai

Fuente: https://link.springer.com/







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