Document Detail

Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients.
MedLine Citation:
PMID:  10923722     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We wished to investigate whether volume recruitment maneuvers (VRMs) could improve alveolar recruitment and oxygenation in acute respiratory distress syndrome (ARDS) patients, ventilated at relatively low positive end-expiratory pressure (PEEP). SETTING: General intensive care unit (ICU) located in a teaching hospital. PATIENTS: 15 PEEP responder ARDS patients undergoing continuous positive pressure ventilation (CPPV) with sedation and muscle paralysis. INTERVENTIONS: We identified a low (9.4 +/- 3 cmH2O) and a high (16.0 +/- 2 cmH2O) level of PEEP associated with target oxygenation values. Using a custom modified mechanical ventilator, we applied in random order three steps lasting 30 min: (1) CPPV at the low PEEP level (CPPV(LO)); (2) CPPV at the high PEEP level (CPPV(HI)); (3) CPPV at low PEEP with the superimposition of periodic VRMs (CPPV(VRM)). VRMs were performed twice a minute by increasing PEEP to the high level for two breaths. Each brace of two breaths was spaced 30 seconds from the preceding one. MEASUREMENTS AND RESULTS: We measured gas exchange, hemodynamics, respiratory mechanics, and the end expiratory lung volume (EELV). Compared to CPPV(LO), CPPV(VRM) resulted in higher PaO2 (117.9 +/- 40.6 vs 79.4 +/- 13.6 mmHg, P < 0.01) and EELV (1.50 +/- 0.62 vs 1.26 +/- 0.50 l, P < 0.05), and in lower venous admixture (Q(VA)/Q(T)) (0.42 +/- 0.07 vs 0.48 +/- 0.07, P < 0.01). During CPPV(HI), we observed significantly higher PaO2 (139.3 +/- 32.5 mmHg) and lower Q(VA)/Q(T) (0.37 +/- 0.08) compared to CPPV(LO) (P < 0.01) and to CPPV(VRM) (P < 0.05). CONCLUSIONS: VRMs can improve oxygenation and alveolar recruitment during CPPV at relatively low PEEP, but are relatively less effective than a continuous high PEEP level.
G Foti; M Cereda; M E Sparacino; L De Marchi; F Villa; A Pesenti
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Intensive care medicine     Volume:  26     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-11-22     Completed Date:  2000-11-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  501-7     Citation Subset:  IM    
Department of Anesthesia and Intensive Care, Nuovo Ospedale S. Gerardo dei Tintori, Monza, Italy.
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MeSH Terms
Blood Gas Analysis
Middle Aged
Positive-Pressure Respiration / methods*
Pulmonary Gas Exchange
Random Allocation
Respiration, Artificial
Respiratory Distress Syndrome, Adult / therapy*
Tidal Volume
Comment In:
Intensive Care Med. 2000 May;26(5):491-2   [PMID:  10923719 ]

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