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Rapid reduction of oxygenation index by employment of a recruitment technique in patients with severe ARDS

Background

Mechanical ventilation of patients with ARDS may contribute to pulmonary injury and systemic inflammation. The objective of this study was to examine the safety and efficacy of a recruitment maneuver which, if successful, would rapidly improve atelectasis and oxygenation and in so doing reduce the potential for ventilator induced lung injury.

Methods

Nineteen patients with severe ARDS (defined as PaO2/FiO2 ≤ 150) from diverse etiologies were turned prone and a positive pressure of 40 cmH2O was applied for a period of 90 s. This pressure was increased in 5 cmH2O increments in subsequent maneuvers to a maximum of 50 cmH2O if there was an inadequate initial response. Subsequently, pressure limited mechanical ventilation with a PEEP of 15 cmH2O was instituted to preventderecruitment. Peak pressures were maintained at ≤ 35 cmH2O. Outcome measures were oxygenation index, PaO2/FiO2 ratio and alveolar-arterial oxygen difference.

Results

The oxygenation index decreased from a median of 31 cmH2O to 14 cmH2O/mmHg immediately post recruitment and to 11 cmH2O/mmHg (P < 0.0001) 24 hours later. The A-aDO2 improved from 454 mmHg to 128 mmHg (P < 0.0001) and the PaO2/FiO2 ratio from 75 to 218 (P < 0.0001) 24 hours later. 25% of patients had PaO2/FiO2 ratio of 300 mmHg at 24 hours. Mean airway pressure increased by 3 cmH2O initially, from 23 cmH2O to 26 cmH2O (NS) as a consequence of the increase of PEEP but his had decreased to 25 cmH2O after 24 hours. There were no significant complications.

Conclusion

Rapid reductions in FiO2 can be achieved safely by the implementation of a relatively simple recruitment technique.

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Richards, G., White, H. & Hopley, M. Rapid reduction of oxygenation index by employment of a recruitment technique in patients with severe ARDS. Crit Care 5, P023 (2001). https://doi.org/10.1186/cc1092

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Keywords

  • Mechanical Ventilation
  • Emergency Medicine
  • Lung Injury
  • Systemic Inflammation
  • Airway Pressure