title: Safety and efficacy of a sustained inflation for alveolar recruitment in adults with respiratory failure.
abstract: OBJECTIVE
  To assess the safety and efficacy of a sustained inflation, used as a lung volume recruitment maneuver in ventilated patients with hypoxemic respiratory failure.
  
  
  METHODS
  Prospective data collection as part of a quality assurance program following introduction of a lung volume recruitment guideline in the intensive care unit.
  
  
  METHODS
  Academic medical-surgical critical care unit.
  
  
  METHODS
  Hypoxemic patients with bilateral pulmonary infiltrates. Patients with chronic obstructive pulmonary disease, pulmonary barotrauma and hemodynamic instability were excluded.
  
  
  METHODS
  A sustained inflation using a pressure of 30 to 45 cmH2O was applied for 20 s. The pressure was determined as the lesser of 45 cmH2O or the peak pressure while ventilated at a tidal volume of 12 ml/kg. Intra-arterial blood pressure and pulse oximetry were monitored continuously.
  
  
  RESULTS
  Significant improvement in oxygenation occurred in the majority of patients within 10 min. The mean oxygen saturation improved from 86.9 +/- 5.5 to 94.3 +/- 2.3% (p < 0.01). No significant adverse effects were noted: hypotension and mild oxygen desaturation occurred in some patients during the 20-s inflation, reversing rapidly after inflation was terminated. No barotrauma occurred.
  
  
  CONCLUSIONS
  A sustained inflation is a safe, clinically applicable method of lung volume recruitment which improves oxygenation in selected patients and may have a role in ventilatory management.
authors.affiliation: Department of Medicine, Mount Sinai Hospital, Ontario, Canada. stephen.lapinsky@utoronto.ca
authors.forename: S E
authors.initials: SE
authors.lastname: Lapinsky
authors.forename: M
authors.initials: M
authors.lastname: Aubin
authors.forename: S
authors.initials: S
authors.lastname: Mehta
authors.forename: P
authors.initials: P
authors.lastname: Boiteau
authors.forename: A S
authors.initials: AS
authors.lastname: Slutsky
mesh_terms: D003422:Critical Care / Q000379:methods; D006801:Humans; D010100:Oxygen / Q000097:blood*; D011175:Positive-Pressure Respiration / Q000379:methods; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000503:physiopathology* / Q000628:therapy*
chemical_list: D010100:Oxygen