Alveolar recruitment maneuver in patients with subarachnoid hemorrhage and acute respiratory distress syndrome: a comparison of 2 approaches.
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.
Nemer
Sérgio N
SN
Hospital de Clínicas de Niterói, Rua La Salle 12, Centro, Niterói, Rio de Janeiro 24020-090, Brazil. snnemer@urbi.com.br
Caldeira
Jefferson B
JB
Azeredo
Leandro M
LM
Garcia
João Márcio
JM
Silva
Ricardo T
RT
Prado
Darwin
D
Santos
Ricardo G
RG
Guimarães
Bruno S
BS
Ramos
Rodrigo A
RA
Noé
Rosângela A
RA
Souza
Paulo Cesar P
PC
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
D010100:Oxygen