Introduction
Acute respiratory distress syndrome (ARDS) is a frequent complication in critically ill patients. Recruitment maneuver (RM) is a rescue procedure which improves oxygenation [1–3]. However, it is not clear whether improving oxygen delivery (DO2) exists after RM. The aim of this study was to evaluate the effects of RM on hemodynamics and DO2.
Methods
A prospective, randomized trial in ARDS patients (AECC criteria). The protocol was approved by the local ethics committee. Fifty-seven patients with extrapulmonary ARDS were randomized into three groups: group A (n = 17) - 40 × 40 RM (CPAP 40 cmH2O for 40 seconds), group B (n = 17) - PCV RM (PIP 40 to 50 cmH2O, PEEP 18 to 20 cmH2O for 120 seconds), and group C (n = 17) - stepwise PCV RM. Gas exchange and systemic hemodynamics by aortal blood flow (transesophageal Doppler; ARROW, USA) were measured before, after, 30 and 120 minutes after RM.
Results
In all groups we observed rapid increasing of paO2 (mmHg) from 65.9 ± 24.9; 77.2 ± 14.0; 87.0 ± 16.7 to 110.3 ± 38.7; 124.5 ± 45.5; 115.2 ± 32.6 (P < 0.0001) after RM. We also observed significant improvement of oxygenation 120 minutes after RM (95.6 ± 25.6; 99.3 ± 25.3; 108.1 ± 26.8). There was no statistical difference between groups. Contrarily, DO2 (ml/minute/m2) after RM statistically significantly decreased from 709.5 ± 297.5; 804.9 ± 217.3; 811.7 ± 638.3 to 569.8 ± 211.9; 675.5 ± 244.7; 661.7 ± 421.3 (P = 0.053) and lasted more than 2 hours. The reason for this alteration was decreasing of cardiac output (CO) from 5.3 ± 2.5 l/minute to 3.6 ± 1.7 l/minute (P < 0.0001) after RM. We hypothesized that the main reason for decreasing CO is rapid increasing of intrathoracic pressure during RM.
Conclusion
Three different RMs increase oxygenation and decrease CO equally. But RM does not improve oxygen delivery due to decreasing CO.
References
Marini JJ, Amato MB: Lung recruitment during ARDS. In Acute Lung Injury. Edited by: Marini JJ, Evans TW. Berlin: Springer; 1998:236-257.
Odenstedt H, Lindgren S, et al.: Slow moderate pressure recruitment maneuver minimizes negative circulatory and lung mechanic side effects: evaluation of recruitment maneuvers using electric impedance tomography. Intensive Care Med 2005, 31: 1706-1714. 10.1007/s00134-005-2799-6
Medoff BD, Harris RS, Kesselman H, et al.: Use of recruitment maneuvers and high-positive end-expiratory pressure in a patient with acute respiratory distress syndrome. Crit Care Med 2000, 28: 1210-1216. 10.1097/00003246-200004000-00051
Author information
Authors and Affiliations
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Protsenko, D., Magomedov, R., Ignatenko, O. et al. Hemodynamics effects of recruitment maneuver. Crit Care 16 (Suppl 1), P108 (2012). https://doi.org/10.1186/cc10715
Published:
DOI: https://doi.org/10.1186/cc10715