A recruitment manoeuvre performed after endotracheal suction does not increase dynamic compliance in ventilated paediatric patients: a randomised controlled trial.
OBJECTIVE
Does a recruitment manoeuvre after suctioning have any immediate or short-term effect on ventilation and gas exchange in mechanically-ventilated paediatric patients?


METHODS
Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.


METHODS
Forty-eight paediatric patients with heterogeneous lung pathology. Fourteen patients were subsequently excluded from analysis due to large leaks around the endotracheal tube.


METHODS
The experimental group received a single standardised suctioning procedure followed five minutes later by a standardised recruitment manoeuvre. The control group received only the single suctioning procedure.


METHODS
Measurements of ventilation (dynamic lung compliance, expiratory airway resistance, mechanical and spontaneous expired tidal volume, respiratory rate) and gas exchange (transcutaneous oxygen saturation) were recorded, on three occasions before and on two occasions after the recruitment manoeuvre, using a respiratory profile monitor.


RESULTS
There was no difference between the experimental and the control group in dynamic compliance, expired airway resistance, or oxygen saturation either immediately after the recruitment manoeuvre, or after 25 minutes. The experimental group decreased mechanical expired tidal volume by 0.3 ml/kg (95% CI 0.1 to 0.6), increased spontaneous expired tidal volume by 0.3 ml/kg (95% CI 0.0 to 0.6), and increased total respiratory rate by 3 bpm (95% CI 1 to 4) immediately after the recruitment manoeuvre compared with the control group, but these differences disappeared after 25 minutes.


CONCLUSIONS
There is insufficient evidence to support performing recruitment manoeuvres after suctioning infants and children.
Morrow
Brenda
B
University of Cape Town, South Africa. brenda.morrow@uct.ac.za
Futter
Merle
M
Argent
Andrew
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007327:Insufflation / Q000379:methods*; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008170:Lung Compliance / Q000502:physiology; D008297:Male; D010100:Oxygen / Q000008:administration & dosage; D011175:Positive-Pressure Respiration / Q000379:methods*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012121:Respiration, Artificial; D015656:Respiratory Mechanics / Q000502:physiology*; D016037:Single-Blind Method; D013396:Suction / Q000009:adverse effects*; D013990:Tidal Volume / Q000502:physiology; D016896:Treatment Outcome
D010100:Oxygen