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Effect of alveolar recruitment maneuver in early acute respiratory distress syndrome according to antiderecruitment strategy, etiological category of diffuse lung injury, and body position of the patient.
Crit Care Med. 2003 Feb; 31(2):411-8.CC

Abstract

OBJECTIVE

To assess how the level of positive end-expiratory pressure (PEEP) (antiderecruitment strategy), etiological category of diffuse lung injury, and body position of the patient modify the effect of the alveolar recruitment maneuver (ARM) in acute respiratory distress syndrome (ARDS).

DESIGN

Prospective clinical trial.

SETTING

Medical intensive care unit at a tertiary hospital.

PATIENTS

Forty-seven patients with early ARDS, including 19 patients from our preliminary study.

INTERVENTION

From baseline ventilation at a tidal volume of 8 mL/kg and PEEP of 10 cm H2O, the ARM (a stepwise increase in the level of PEEP up to 30 cm H2O with a concomitant decrease in the magnitude of tidal volume down to 2 mL/kg) was given with (ARM + PEEP, n = 20) or without (ARM only, n = 19) subsequent increase of PEEP to 15 cm H2O. In eight other patients, PEEP was increased to 15 cm H2O without a preceding ARM (PEEP only).

MEASUREMENTS AND RESULTS

In all three groups, Pao2 was increased by the respective intervention (all p<.05). In the ARM-only group, Pao2 at 15 mins after intervention was lower than Pao2 immediate after intervention (p =.046). In the ARM + PEEP group, no such decrease in Pao2 was observed, and Pao2 at 15, 30, 45, and 60 mins after intervention was higher than in the ARM-only group (all p<.05). Compared with the PEEP-only group, Pao2 of the ARM + PEEP group was higher immediately after intervention and at the later time points (all p <.05). Compared with patients with ARDS associated with direct lung injury (pulmonary ARDS), patients with ARDS associated with indirect lung injury (extrapulmonary ARDS) showed a greater increase in Pao2 (27 +/- 21% vs. 130 +/- 112%; p=.002) and a greater decrease in radiologic scores (1.0 +/- 2.4 vs. 3.4 +/- 1.5; p=.005) after the ARM. The increase in Pao2 induced by the ARM was greater for patients in the supine position than for patients in the prone position (61 +/- 82% vs. 21 +/- 14%; p=.028). Consequently, Pao immediately after the ARM was similar in the two groups of patients in different positions.

CONCLUSIONS

After the ARM, a sufficient level of PEEP is required as an antiderecruitment strategy. Pulmonary ARDS and extrapulmonary ARDS may be different pathophysiologic entities. An effective ARM may obviate the need for the prone position in ARDS at least in terms of oxygenation.

Authors+Show Affiliations

Department of Internal Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12576945

Citation

Lim, Chae-Man, et al. "Effect of Alveolar Recruitment Maneuver in Early Acute Respiratory Distress Syndrome According to Antiderecruitment Strategy, Etiological Category of Diffuse Lung Injury, and Body Position of the Patient." Critical Care Medicine, vol. 31, no. 2, 2003, pp. 411-8.
Lim CM, Jung H, Koh Y, et al. Effect of alveolar recruitment maneuver in early acute respiratory distress syndrome according to antiderecruitment strategy, etiological category of diffuse lung injury, and body position of the patient. Crit Care Med. 2003;31(2):411-8.
Lim, C. M., Jung, H., Koh, Y., Lee, J. S., Shim, T. S., Lee, S. D., Kim, W. S., Kim, D. S., & Kim, W. D. (2003). Effect of alveolar recruitment maneuver in early acute respiratory distress syndrome according to antiderecruitment strategy, etiological category of diffuse lung injury, and body position of the patient. Critical Care Medicine, 31(2), 411-8.
Lim CM, et al. Effect of Alveolar Recruitment Maneuver in Early Acute Respiratory Distress Syndrome According to Antiderecruitment Strategy, Etiological Category of Diffuse Lung Injury, and Body Position of the Patient. Crit Care Med. 2003;31(2):411-8. PubMed PMID: 12576945.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of alveolar recruitment maneuver in early acute respiratory distress syndrome according to antiderecruitment strategy, etiological category of diffuse lung injury, and body position of the patient. AU - Lim,Chae-Man, AU - Jung,Hoon, AU - Koh,Younsuck, AU - Lee,Jin Seoung, AU - Shim,Tae-Sun, AU - Lee,Sang-Do, AU - Kim,Woo-Sung, AU - Kim,Dong Soon, AU - Kim,Won-Dong, PY - 2003/2/11/pubmed PY - 2003/3/26/medline PY - 2003/2/11/entrez SP - 411 EP - 8 JF - Critical care medicine JO - Crit. Care Med. VL - 31 IS - 2 N2 - OBJECTIVE: To assess how the level of positive end-expiratory pressure (PEEP) (antiderecruitment strategy), etiological category of diffuse lung injury, and body position of the patient modify the effect of the alveolar recruitment maneuver (ARM) in acute respiratory distress syndrome (ARDS). DESIGN: Prospective clinical trial. SETTING: Medical intensive care unit at a tertiary hospital. PATIENTS: Forty-seven patients with early ARDS, including 19 patients from our preliminary study. INTERVENTION: From baseline ventilation at a tidal volume of 8 mL/kg and PEEP of 10 cm H2O, the ARM (a stepwise increase in the level of PEEP up to 30 cm H2O with a concomitant decrease in the magnitude of tidal volume down to 2 mL/kg) was given with (ARM + PEEP, n = 20) or without (ARM only, n = 19) subsequent increase of PEEP to 15 cm H2O. In eight other patients, PEEP was increased to 15 cm H2O without a preceding ARM (PEEP only). MEASUREMENTS AND RESULTS: In all three groups, Pao2 was increased by the respective intervention (all p<.05). In the ARM-only group, Pao2 at 15 mins after intervention was lower than Pao2 immediate after intervention (p =.046). In the ARM + PEEP group, no such decrease in Pao2 was observed, and Pao2 at 15, 30, 45, and 60 mins after intervention was higher than in the ARM-only group (all p<.05). Compared with the PEEP-only group, Pao2 of the ARM + PEEP group was higher immediately after intervention and at the later time points (all p <.05). Compared with patients with ARDS associated with direct lung injury (pulmonary ARDS), patients with ARDS associated with indirect lung injury (extrapulmonary ARDS) showed a greater increase in Pao2 (27 +/- 21% vs. 130 +/- 112%; p=.002) and a greater decrease in radiologic scores (1.0 +/- 2.4 vs. 3.4 +/- 1.5; p=.005) after the ARM. The increase in Pao2 induced by the ARM was greater for patients in the supine position than for patients in the prone position (61 +/- 82% vs. 21 +/- 14%; p=.028). Consequently, Pao immediately after the ARM was similar in the two groups of patients in different positions. CONCLUSIONS: After the ARM, a sufficient level of PEEP is required as an antiderecruitment strategy. Pulmonary ARDS and extrapulmonary ARDS may be different pathophysiologic entities. An effective ARM may obviate the need for the prone position in ARDS at least in terms of oxygenation. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/12576945/Effect_of_alveolar_recruitment_maneuver_in_early_acute_respiratory_distress_syndrome_according_to_antiderecruitment_strategy_etiological_category_of_diffuse_lung_injury_and_body_position_of_the_patient_ L2 - https://dx.doi.org/10.1097/01.CCM.0000048631.88155.39 DB - PRIME DP - Unbound Medicine ER -