title: Alveolar recruitment maneuver in patients with subarachnoid hemorrhage and acute respiratory distress syndrome: a comparison of 2 approaches.
abstract: OBJECTIVE
  The purpose of the study was to compare 2 alveolar recruitment maneuvers (ARMs) approaches in patients with subarachnoid hemorrhage (SAH) and acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  Sixteen SAH patients with ARDS were randomized in 2 similar groups. One received ARM with continuous positive airway pressure (CPAP) of 35 cm H(2)O for 40 seconds (CPAP recruitment), whereas the other received pressure control ventilation with positive-end expiratory pressure of 15 cm H(2)O and pressure control above positive end-expiratory pressure of 35 cm H(2)O for 2 minutes (pressure control recruitment maneuver [PCRM]). Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were measured before and after ARM. The ratio of arterial oxygen tension to fraction of inspired oxygen was measured before and 1 hour after the ARM.
  
  
  RESULTS
  After ARM, ICP was higher in CPAP recruitment (20.50 ± 4.75 vs 13.13 ± 3.56 mm Hg; P = .003); and CPP was lower in CPAP recruitment (62.38 ± 9.81 vs 79.60 ± 6.8 mm Hg; P = .001). One hour after the ARM, the ratio of arterial oxygen tension to fraction of inspired oxygen increased significantly only in PCRM (108.5 to 203.6; P = .0078).
  
  
  CONCLUSIONS
  In SAH patients with ARDS, PCRM did not affect ICP and decreased CPP in safe levels, besides improving oxygenation.
authors.affiliation: Hospital de Clínicas de Niterói, Rua La Salle 12, Centro, Niterói, Rio de Janeiro 24020-090, Brazil. snnemer@urbi.com.br
authors.forename: Sérgio N
authors.initials: SN
authors.lastname: Nemer
authors.forename: Jefferson B
authors.initials: JB
authors.lastname: Caldeira
authors.forename: Leandro M
authors.initials: LM
authors.lastname: Azeredo
authors.forename: João Márcio
authors.initials: JM
authors.lastname: Garcia
authors.forename: Ricardo T
authors.initials: RT
authors.lastname: Silva
authors.forename: Darwin
authors.initials: D
authors.lastname: Prado
authors.forename: Ricardo G
authors.initials: RG
authors.lastname: Santos
authors.forename: Bruno S
authors.initials: BS
authors.lastname: Guimarães
authors.forename: Rodrigo A
authors.initials: RA
authors.lastname: Ramos
authors.forename: Rosângela A
authors.initials: RA
authors.lastname: Noé
authors.forename: Paulo Cesar P
authors.initials: PC
authors.lastname: Souza
mesh_terms: D000368:Aged; D001930:Brain Injuries / Q000628:therapy; D002560:Cerebrovascular Circulation; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D006801:Humans; D007427:Intracranial Pressure; D010100:Oxygen / Q000008:administration & dosage / Q000097:blood; D011175:Positive-Pressure Respiration / Q000379:methods*; D011650:Pulmonary Alveoli / Q000503:physiopathology*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen