Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Noninvasive continuous positive airway pressure (n-CPAP) has been proposed for the treatment of hypoxemic acute respiratory failure (h-ARF). Recruitment maneuvers were shown to improve oxygenation, i.e., the ratio of arterial oxygen tension to inspiratory oxygen fraction (PaO2/FiO2), during either invasive mechanical ventilation, and n-CPAP, with a response depending on the distribution of lung collapse. We hypothesized that, during n-CPAP, early h-ARF patients with bilateral (BL) distribution of lung involvement would benefit from recruitment maneuvers more than those with unilateral (UL) involvement.
To perform a recruitment maneuver, once a minute we increased the pressure applied to the airway from 10 cmH2O to 25 cmH2O for 8 s (SIGH). We enrolled 24 patients with h-ARF (12 BL and 12 UL) who underwent four consecutive trials: (1) 30 min breathing through a Venturi mask (VMASK), (2) 1 h n-CPAP (n-CPAP1), (3) 1 h n-CPAP plus SIGH (n-CPAPSIGH), and (4) 1 h n-CPAP (n-CPAP2).
Compared to VMASK, n-CPAP at 10 cmH2O delivered via a helmet, increased PaO2/FiO2 and decreased dyspnea in both BL and UL; furthermore, it reduced the respiratory rate and brought PaCO2 up to normal in BL only. Compared to n-CPAP, n-CPAPSIGH significantly improved PaO2/FiO2 in BL (225 ± 88 vs. 308 ± 105, respectively), whereas it produced no further improvement in PaO2/FiO2 in UL (232 ± 72 vs. 231 ± 77, respectively). SIGH did not affect hemodynamics in both groups.
Compared to n-CPAP, n-CPAPSIGH further improved arterial oxygenation in BL patients, whereas it produced no additional benefit in those with UL.
- Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure
Intensive Care Medicine
Volume 37, Issue 7 , pp 1095-1102
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Noninvasive CPAP
- Recruitment maneuvers
- Industry Sectors
- Author Affiliations
- 1. Università del Piemonte Orientale “Amedeo Avogadro”-Alessandria-Novara-Vercelli, Dipartimento di Medicina Clinica e Sperimentale, Anesthesia and Intensive Care, University Hospital “Maggiore della Carità”, Via Solaroli 17, 28100, Novara, Italy
- 2. Department of Anesthesiology and Intensive Care, Università Cattolica del Sacro Cuore, Agostino Gemelli University Hospital, Rome, Italy