Intensive Care Medicine

, Volume 37, Issue 7, pp 1095–1102

Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure

  • Gianmaria Cammarota
  • Rosanna Vaschetto
  • Emilia Turucz
  • Fabrizio Dellapiazza
  • Davide Colombo
  • Cristiana Blando
  • Francesco Della Corte
  • Salvatore Maurizio Maggiore
  • Paolo Navalesi
Original

DOI: 10.1007/s00134-011-2239-8

Cite this article as:
Cammarota, G., Vaschetto, R., Turucz, E. et al. Intensive Care Med (2011) 37: 1095. doi:10.1007/s00134-011-2239-8

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

Compared to n-CPAP, n-CPAPSIGH further improved arterial oxygenation in BL patients, whereas it produced no additional benefit in those with UL.

Keywords

Noninvasive CPAP Recruitment maneuvers 

Supplementary material

134_2011_2239_MOESM1_ESM.doc (55 kb)
Supplementary material 1 (DOC 55 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Gianmaria Cammarota
    • 1
  • Rosanna Vaschetto
    • 1
  • Emilia Turucz
    • 1
  • Fabrizio Dellapiazza
    • 1
  • Davide Colombo
    • 1
  • Cristiana Blando
    • 1
  • Francesco Della Corte
    • 1
  • Salvatore Maurizio Maggiore
    • 2
  • Paolo Navalesi
    • 1
  1. 1.Università del Piemonte Orientale “Amedeo Avogadro”-Alessandria-Novara-Vercelli, Dipartimento di Medicina Clinica e Sperimentale, Anesthesia and Intensive CareUniversity Hospital “Maggiore della Carità”NovaraItaly
  2. 2.Department of Anesthesiology and Intensive Care, Università Cattolica del Sacro CuoreAgostino Gemelli University HospitalRomeItaly

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