Recruitment maneuver in prevention of hypoxia during percutaneous dilational tracheostomy: randomized trial.
BACKGROUND
Percutaneous dilational tracheostomy (PDT) can potentially lead to hypoxia and alveolar derecruitment. The aim of this prospective study was to evaluate the efficacy of performing a recruitment maneuver (RM) before tracheostomy, in order to improve oxygenation.


METHODS
We enrolled 29 eligible trauma patients with acute lung injury criteria requiring tracheostomy in a university ICU. Subjects were ventilated on volume controlled mechanical ventilation (tidal volume of 6 mL/kg) and F(IO(2)) set at 1.0. Subjects were randomized into 2 groups:  RM group (subjects who underwent RM 10 min before PDT, 15 subjects) and no-RM group (subjects without application of RM before PDT, 14 subjects). RM was performed by imposition of continuous positive airway pressure of 40 cm H(2)O for 40 seconds. We collected gas exchange, respiratory,  and hemodynamic data 5 times: 1 hour before RM, 5 min after RM, 5 min after PDT, 30 min after PDT, and 6 hours after PDT.


RESULTS
Subjects who underwent RM had a significant increase in P(aO(2)); 5 min after the maneuver, P(aO(2)) increased from 222.6 ±  33.4 mm Hg to 341.3 ± 33.1 mm Hg (P < .01) and was always significantly maintained throughout the following times of the study, compared to the no-RM group: in the RM and no-RM groups, respectively, 260.7 ± 35.4 mm Hg vs 108.5 ± 36.9 mm Hg 5 min after PDT; 285.6  ± 29.1 mm Hg vs 188.4 ± 21.4 mm Hg 30 min after PDT; and 226.3 ± 24.8 mm Hg vs 147.6 ± 42.8 mm Hg 6 h after PDT (P < .01).


CONCLUSIONS
Our study suggests that application of RM before PDT could be useful to avoid hypoxemia following such procedure, by  reducing fall in P(aO(2)) and preventing the decrease in oxygenation values below baseline at 6 hours.
Department of Anesthesia and Intensive Care, University of Siena, Siena, Italy. franchif@unisi.it
Federico
F
Franchi
Lucia
L
Cubattoli
Agnese
A
Faltoni
Sabino
S
Scolletta
Elena
E
Falciani
Egidio
E
Mastrocinque
Pierpaolo
P
Giomarelli
Nicoló
N
Patroniti
D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D018709:Statistics, Nonparametric; D014139:Tracheostomy; D016896:Treatment Outcome