Respiratory effects of different recruitment maneuvers in acute respiratory distress syndrome

Abstract

Introduction Alveolar 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.

Lung morphology predicts response to recruitment maneuver in patients with acute respiratory distress syndrome

“…T he aim of recruitment maneuvers (RMs) in acute respiratory distress syndrome (ARDS) and acute lung injury is the reaeration of insufficiently aerated lung regions through an intentional, transient increase in transpulmonary pressure (1)(2)(3). Improving gas exchange and attenuating ventilator-induced lung injury are the major expected benefits through the prevention of repetitive "opening and closing of unstable lung units" (4,5).…”

Optimal duration of a sustained inflation recruitment maneuver in ARDS patients

“…Despite a careful fluid management prior to RM to maintain pulse pressure variation below 13% [32], systolic and mean arterial pressures decreased progressively throughout the RM and became significant at 20 and 30 s with a rapid recovery of the basal condition 30 s after the end of the RM. Overall systolic and mean arterial pressures decreased by a median value of 16 [8-28] mmHg and 8 [2][3][4][5][6][7][8][9][10][11][12][13] mmHg, respectively, from the beginning to the end of the RM. Such an impairment may have clinical consequences, especially as arterial pressure underestimates the true effect of the RM on cardiac output [10].…”

“…A 10-s sustained inflation RM would have limited the decrease in systolic and mean arterial pressures. Studies comparing hemodynamic parameters before and after the RM reported no hemodynamic compromise, probably because of this transient effect [6,13,34]. In animal models, hemodynamic compromise was constant but differed according to the model used (pneumonia being worse than oleic acid injury or VILI) and the RM performed (40-s sustained inflation RM being worse than incremental PEEP) [32].…”

“…Because of viscoelastance and other time-dependent force-distributing phenomena, the tendency of a previously collapsed airway or alveoli to open is a function of both transpulmonary pressure and time [5]. Thus, the most commonly used RM in clinical studies is sustained application of continuous positive airway pressure (CPAP) of 30-50 cmH 2 O for 30-40 s (sustained inflation RM) [6][7][8][9][10][11][12][13]. In an animal model of ARDS, most of the recruitment occurs in the first seconds of sustained inflation RM [14].…”

The effects of different recruitment maneuvers on bacterial translocation and ventilatory induced lung injury

“…[3][4][5] Respiratory effects of different RMs have also been studied. [6] Bacterial translocation from the lungs to the bloodstream has been used as a marker of VILI in a number of experimental…”