[Comparative study on recruitment maneuvers in acute respiratory distress syndrome with pulmonary and extrapulmonary origin].
OBJECTIVE
To study the effects of lung recruitment maneuvers (RM) in acute respiratory distress syndrome (ARDS) with pulmonary and extrapulmonary origin (ARDSp/ARDSexp).


METHODS
Thirty-seven ARDS patients with a forced expiratory volume were selected (16 with ARDSp, 21 with ARDSexp). Without using any sedative and neuromuscular blocking agents, with continuous positive airway pressure (CPAP) up to 30 cm H(2)O (1 cm H(2)O=0.098 kPa), the patients were asked to hold the breath for 30 seconds, and then CPAP was lowered to the level of that before the treatment within 5-10 seconds.


RESULTS
Compared with the state before recruitment, changes in heart rate (HR) were not obvious in two groups during RM, mean arterial pressure was elevated evidently after 2 minutes in two groups (both P<0.05), and central venous pressure (CVP) rose after 30 seconds in two groups (both P<0.05). Peak inspiratory pressure, platform pressure and mean airway pressure increased clearly after 30 seconds (all P<0.05), and pulmonary compliance decreased obviously 30 seconds after re-inflation recruitment in two groups (both P<0.05), and increased obviously in ARDSexp group 5, 15, 30 minutes after recruitment (all P<0.05). In the group with ARDSp oxygenation index (OI) changed distinctly 10, 30 minutes and 1 hour after recruitment compared with the state before recruitment (all P<0.05). In patients with ARDSexp OI was significantly improved 10 minutes, 30 minutes, 1 hour, 2 hours after RM.


CONCLUSIONS
In ARDSexp, with pulmonary interstitial edema as the main pathology, responded better to RM than ARDSp with pulmonary consolidation.
Li
Mao-qin
MQ
Department of Intensive Care Unit, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu, China. limaoqinxi@126.com
Zhang
Zhou
Z
Li
Song-mei
SM
Shi
Zai-xiang
ZX
Xu
Ji-yuan
JY
Lu
Fei
F
Li
Lin
L
Wang
Hui-min
HM
D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D001794:Blood Pressure; D002496:Central Venous Pressure; D045422:Continuous Positive Airway Pressure; D005260:Female; D006339:Heart Rate; D006801:Humans; D008170:Lung Compliance; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome