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Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS.
Acta Anaesthesiol Scand. 2004 Mar; 48(3):287-93.AA

Abstract

BACKGROUND

To evaluate the effect of a recruitment maneuver (RM) with constant positive inspiratory pressure and high positive end-expiratory pressure (PEEP) on oxygenation and static compliance (Cs) in patients with severe acute respiratory distress syndrome (ARDS).

METHODS

Eight patients with ARDS ventilated with lung-protective strategy and an arterial partial pressure of oxygen to inspired oxygen fraction ratio (PaO2/FIO2) < or =100 mmHg regardless of PEEP were prospectively studied. The RM was performed in pressure-controlled ventilation at FIO2 of 1.0 until PaO2 reached 250 mmHg or a maximal plateau pressure/PEEP of 60/45 cmH2O was achieved. The RM was performed with stepwise increases of 5 cmH2O of PEEP every 2 min and thereafter with stepwise decreases of 2 cmH2O of PEEP every 2 min until a drop in PaO2 >10% below the recruitment PEEP level. Data was collected before (preRM), during and after 30 min (posRM).

RESULTS

The PaO2/FIO2 increased from 83 +/- 22 mmHg preRM to 118 +/- 32 mmHg posRM (P = 0.001). The Cs increased from 28 +/- 10 ml cmH2O(-1) preRM to 35 +/- 12 ml cmH2O(-1) posRM (P = 0.025). The PEEP was 12 +/- 3 cmH2O preRM and was set at 15 +/- 4 cmH2O posRM (P = 0.025). The PEEP of recruitment was 36 +/- 9 cmH2O and the collapsing PEEP was 13 +/- 4 cmH2O. The PaO2 of recruitment was 225 +/- 105 mmHg, with five patients reaching a PaO2 > or = 250 mmHg. The FIO2 decreased from 0.76 +/- 0.16 preRM to 0.63 +/- 0.15 posRM (P = 0.001). No major complications were detected.

CONCLUSION

Recruitment maneuver was safe and useful to improve oxygenation and Cs in patients with severe ARDS ventilated with lung-protective strategy.

Authors+Show Affiliations

Unidade de Cuidados Intensivos, Hospital Garcia de Orta, Pragal, Almada, Portugal. povoap@netcabo.ptNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

14982560

Citation

Póvoa, P, et al. "Evaluation of a Recruitment Maneuver With Positive Inspiratory Pressure and High PEEP in Patients With Severe ARDS." Acta Anaesthesiologica Scandinavica, vol. 48, no. 3, 2004, pp. 287-93.
Póvoa P, Almeida E, Fernandes A, et al. Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS. Acta Anaesthesiol Scand. 2004;48(3):287-93.
Póvoa, P., Almeida, E., Fernandes, A., Mealha, R., Moreira, P., & Sabino, H. (2004). Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS. Acta Anaesthesiologica Scandinavica, 48(3), 287-93.
Póvoa P, et al. Evaluation of a Recruitment Maneuver With Positive Inspiratory Pressure and High PEEP in Patients With Severe ARDS. Acta Anaesthesiol Scand. 2004;48(3):287-93. PubMed PMID: 14982560.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS. AU - Póvoa,P, AU - Almeida,E, AU - Fernandes,A, AU - Mealha,R, AU - Moreira,P, AU - Sabino,H, PY - 2004/2/26/pubmed PY - 2004/6/23/medline PY - 2004/2/26/entrez SP - 287 EP - 93 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 48 IS - 3 N2 - BACKGROUND: To evaluate the effect of a recruitment maneuver (RM) with constant positive inspiratory pressure and high positive end-expiratory pressure (PEEP) on oxygenation and static compliance (Cs) in patients with severe acute respiratory distress syndrome (ARDS). METHODS: Eight patients with ARDS ventilated with lung-protective strategy and an arterial partial pressure of oxygen to inspired oxygen fraction ratio (PaO2/FIO2) < or =100 mmHg regardless of PEEP were prospectively studied. The RM was performed in pressure-controlled ventilation at FIO2 of 1.0 until PaO2 reached 250 mmHg or a maximal plateau pressure/PEEP of 60/45 cmH2O was achieved. The RM was performed with stepwise increases of 5 cmH2O of PEEP every 2 min and thereafter with stepwise decreases of 2 cmH2O of PEEP every 2 min until a drop in PaO2 >10% below the recruitment PEEP level. Data was collected before (preRM), during and after 30 min (posRM). RESULTS: The PaO2/FIO2 increased from 83 +/- 22 mmHg preRM to 118 +/- 32 mmHg posRM (P = 0.001). The Cs increased from 28 +/- 10 ml cmH2O(-1) preRM to 35 +/- 12 ml cmH2O(-1) posRM (P = 0.025). The PEEP was 12 +/- 3 cmH2O preRM and was set at 15 +/- 4 cmH2O posRM (P = 0.025). The PEEP of recruitment was 36 +/- 9 cmH2O and the collapsing PEEP was 13 +/- 4 cmH2O. The PaO2 of recruitment was 225 +/- 105 mmHg, with five patients reaching a PaO2 > or = 250 mmHg. The FIO2 decreased from 0.76 +/- 0.16 preRM to 0.63 +/- 0.15 posRM (P = 0.001). No major complications were detected. CONCLUSION: Recruitment maneuver was safe and useful to improve oxygenation and Cs in patients with severe ARDS ventilated with lung-protective strategy. SN - 0001-5172 UR - https://www.unboundmedicine.com/medline/citation/14982560/Evaluation_of_a_recruitment_maneuver_with_positive_inspiratory_pressure_and_high_PEEP_in_patients_with_severe_ARDS_ L2 - https://doi.org/10.1111/j.0001-5172.2004.0305.x DB - PRIME DP - Unbound Medicine ER -