Tuberc Respir Dis.  2007 Nov;63(5):423-429. 10.4046/trd.2007.63.5.423.

The Effect and Safety of Alveolar Recruitment Maneuver using Pressure-Controlled Ventilation in Acute Lung Injury and Acute Respiratory Distress Syndrome

• Chung KS
• Park BH
• Shin SY
• Jeon HH
• Park SC
• Kang SM
• Park MS
• Han CH
• Kim CJ
• Lee SM
• Kim SK
• Chang J
• Kim SK
• Kim YS

• KMID: 2050475
• DOI: http://doi.org/10.4046/trd.2007.63.5.423

Abstract

BACKGROUND: Alveolar recruitment (RM) is one of the primary goals of respiratory care for an acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The purposes of alveolar recruitment are an improvement in pulmonary gas exchange and the protection of atelectrauma. This study examined the effect and safety of the alveolar RM using pressure control ventilation (PCV) in early ALI and ARDS patients.
METHODS
Sixteen patients with early ALI and ARDS who underwent alveolar RM using PCV were enrolled in this study. The patients' data were recorded at the baseline, and 20 minutes, and 60 minutes after alveolar RM, and on the next day after the maneuver. Alveolar RM was performed with an inspiratory pressure of 30 cmH2O and a PEEP of 20 cmH2O in a 2-minute PCV mode. The venous O2 saturation, central venous pressure, blood pressure, pulse rate, PaO2/FiO2 ratio, PEEP, and chest X-ray findings were obtained before and after alveolar RM.
RESULTS
Of the 16 patients, 3 had extra-pulmonary ALI/ARDS and the remaining 13 had pulmonary ALI/ARDS. The mean PEEP was 11.3 mmHg, and the mean PaO2/FiO2 ratio was 130.3 before RM. The PaO2/FiO2 ratio increased by 45% after alveolar RM. The PaO2/FiO2 ratio reached a peak 60 minutes after alveolar RM. The PaCO2 increased by 51.9 mmHg after alveolar RM. The mean blood pressure was not affected by alveolar RM. There were no complications due to pressure injuries such as a pneumothorax, pneumomediastinum, and subcutaneous emphysema.
CONCLUSION
In this study, alveolar RM using PCV improved the level of oxygenation in patients with an acute lung injury and acute respiratory distress syndrome. Moreover, there were no significant complications due to hemodynamic changes and pressure injuries. Therefore, alveolar RM using PCV can be applied easily and safely in clinical practice with lung protective strategy in early ALI and ARDS patients.

Keyword

Recruitment maneuvers; Acute lung injury; Acute respiratory distress syndrome; Pressure-controlled ventilation

MeSH Terms

Acute Lung Injury*
Blood Pressure
Central Venous Pressure
Heart Rate
Hemodynamics
Humans
Lung
Mediastinal Emphysema
Oxygen
Pneumothorax
Pulmonary Gas Exchange
Respiratory Distress Syndrome, Adult*
Subcutaneous Emphysema
Thorax
Ventilation*
Oxygen

Figure

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  Figure 1 Change of PaO2/FiO2 ratios (median value) at baseline, and 20 mins, 60 mins, and on the next day after the Alveolar RM of Responders, Non-responders and Total Subjects. *Average 10 hours after recruitment maneuver.

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