Safety and efficacy of a sustained inflation for alveolar recruitment in adults with respiratory failure.
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.
Lapinsky
S E
SE
Department of Medicine, Mount Sinai Hospital, Ontario, Canada. stephen.lapinsky@utoronto.ca
Aubin
M
M
Mehta
S
S
Boiteau
P
P
Slutsky
A S
AS
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*
D010100:Oxygen