Acute hemodynamic effects of recruitment maneuvers in patients with acute respiratory distress syndrome.
BACKGROUND
The recruitment maneuver (RM) in acute respiratory distress syndrome (ARDS) can cause hemodynamic derangement. We evaluated circulatory and cardiac changes during RMs.


METHODS
We performed sustained inflation (SI) with a pressure of 40 cm H(2)O for 30 seconds as an RM on 22 patients with ARDS. Blood pressure (BP) and heart rate were recorded immediately before, every 10 seconds during, and 30 seconds after the RM. Ventricular dimensions were obtained simultaneously using M-mode echocardiography, and tissue Doppler imaging was performed on the left ventricular wall.


RESULTS
Mean, systolic, and diastolic BP decreased at 20 and 30 seconds during 30-second RMs (mean BP: 92 +/- 12 at baseline to 83 +/- 18 mm Hg at the end of the RM, P < .05) and subsequently recovered. Heart rate decreased at 10 and 20 seconds during the RM, and tended to increase afterward. Both ventricular dimensions decreased significantly during the RM. The left ventricular ejection fraction and peak velocity of the left ventricle during systole remained stable. The fractional changes in mean BP and left ventricular end-diastolic dimension during the RMs were correlated significantly with each other (r(s) = 0.59). Static compliance of the respiratory system (Crs) was lower in patients with mean BP change > or =15% than in patients in whom the change was <15% (P < .05).


CONCLUSIONS
A transient decrease in mean BP was observed during the RM, and its degree was correlated with the preload decrease, while cardiac contractility was maintained.
Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea. parkkj@ajou.ac.kr
Kwang Joo
KJ
Park
Yoon Jung
YJ
Oh
Hyuk Jae
HJ
Chang
Seung Soo
SS
Sheen
Junghyun
J
Choi
Keu Sung
KS
Lee
Joo Hun
JH
Park
Sung Chul
SC
Hwang
D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D004452:Echocardiography / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome