Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS.
BACKGROUND
To evaluate the effect of a recruitment maneuver (RM) with constant positive inspiratory pressure and high positive end-expiratory pressure (PEEP) on oxygenation and static compliance (Cs) in patients with severe acute respiratory distress syndrome (ARDS).


METHODS
Eight patients with ARDS ventilated with lung-protective strategy and an arterial partial pressure of oxygen to inspired oxygen fraction ratio (PaO2/FIO2) < or =100 mmHg regardless of PEEP were prospectively studied. The RM was performed in pressure-controlled ventilation at FIO2 of 1.0 until PaO2 reached 250 mmHg or a maximal plateau pressure/PEEP of 60/45 cmH2O was achieved. The RM was performed with stepwise increases of 5 cmH2O of PEEP every 2 min and thereafter with stepwise decreases of 2 cmH2O of PEEP every 2 min until a drop in PaO2 >10% below the recruitment PEEP level. Data was collected before (preRM), during and after 30 min (posRM).


RESULTS
The PaO2/FIO2 increased from 83 +/- 22 mmHg preRM to 118 +/- 32 mmHg posRM (P = 0.001). The Cs increased from 28 +/- 10 ml cmH2O(-1) preRM to 35 +/- 12 ml cmH2O(-1) posRM (P = 0.025). The PEEP was 12 +/- 3 cmH2O preRM and was set at 15 +/- 4 cmH2O posRM (P = 0.025). The PEEP of recruitment was 36 +/- 9 cmH2O and the collapsing PEEP was 13 +/- 4 cmH2O. The PaO2 of recruitment was 225 +/- 105 mmHg, with five patients reaching a PaO2 > or = 250 mmHg. The FIO2 decreased from 0.76 +/- 0.16 preRM to 0.63 +/- 0.15 posRM (P = 0.001). No major complications were detected.


CONCLUSIONS
Recruitment maneuver was safe and useful to improve oxygenation and Cs in patients with severe ARDS ventilated with lung-protective strategy.
Unidade de Cuidados Intensivos, Hospital Garcia de Orta, Pragal, Almada, Portugal. povoap@netcabo.pt
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D000293:Adolescent; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D001239:Inhalation / Q000502:physiology*; D008170:Lung Compliance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000502:physiology; D010102:Oxygen Inhalation Therapy; D011175:Positive-Pressure Respiration / Q000379:methods*; D011312:Pressure; D011446:Prospective Studies; D011650:Pulmonary Alveoli / Q000503:physiopathology; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
D002245:Carbon Dioxide; D010100:Oxygen