[The analysis of 252 episodes of recruitment maneuver during mechanical ventilation in surgery intensive care unit].
OBJECTIVE
To analyze the clinical effects of recruitment maneuver and the impacts on blood pressure and oxygen saturation in patients with mechanical ventilation.


METHODS
To analyze all related data from 252 episodes of recruitment maneuver of 46 patients admitted from July 2005 to February 2007. Recruitment maneuver method: the drive pressure constant was kept at 15 cm H(2)O (1 cm H(2)O=0.098 kPa) and the positive end-expiratory pressure (PEEP) level was increased gradually.


RESULTS
Of the 252 episodes of recruitment maneuver, this procedure was effective in 91% of the patients, with pneumothorax and pneumo-mediastinum occurred in a patient with legionnaire pneumonia, and no improvement of oxygen saturation in one patient with patent foramen ovale. The value of effective PEEP used ranged from a minimum of 8 cm H(2)O to a maximum of 30 cm H(2)O and the duration of satisfactory oxygen saturation ranged from a minimum of 0.4 hour to a maximum of 368 hours. On average, each patient received 5.48 episodes of recruitment maneuver with one of the patients received 16 episodes of recruitment maneuver. Twenty-three out of the 46 patients (50%) had experienced an episode of hypoxemia. One hundred and one episodes of hypoxemia occurred in 252 recruitment maneuver (40%) and the minimum PEEP inducing hypoxemia is 8 cm H(2)O, and the maximum PEEP was 22 cm H(2)O, with an average value of 12.7 cm H(2)O. Twenty-five of the 46 patients (54%) had experienced transient hypotension with 93 episodes of hypoxemia in 252 episodes of recruitment maneuver (37%), and the minimum PEEP inducing hypotension was 6 cm H(2)O and the maximum PEEP was 23 cm H(2)O, with an average value of 13.9 cm H(2)O.


CONCLUSIONS
Recruitment maneuver could effectively improve oxygenation while the value of PEEP used should be individualized according to clinical condition.
Yang
Zi-Jian
ZJ
Surgery Intensive Care Unit, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
Zhang
Xiang-Yu
XY
Fan
Hai-Rong
HR
Jiang
Xin
X
Wang
Qi-Xing
QX
Shen
Ju-Fang
JF
Chen
Liang
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D000860:Hypoxia / Q000209:etiology / Q000517:prevention & control; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
D010100:Oxygen