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Effects of recruitment maneuver and positive end-expiratory pressure on hypoxemia after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism
Critical Care volume 8, Article number: P27 (2004)
Effects of recruitment maneuver (RM) and high positive end-expiratory pressure (PEEP) are still controversial in patients with hypoxemia. In this prospective study, we tested the hypotheses that RM improved oxygenation in patients with hypoxemia after pulmonary thromboendarterectomy (PTE) for chronic pulmonary thromboembolism (CPTE) and that the response to RM and PEEP changed with time.
We enrolled 14 patients (58 ± 10 years) who underwent elective PTE for CPTE and developed hypoxemia (PaO2 < 300 torr at FIO2 of 1.0). We performed RM and PEEP trial twice at FIO2 of 1.0; 1–2 hours after the surgery (first) and 12 hours later (second trial). As a RM, we increased the PEEP to 30 cmH2O for 1 min during pressure control ventilation. Then we decreased PEEP stepwise (15, 10, 5, and 0 cmH2O) at 15–20 min intervals. Ventilatory settings were unchanged throughout the measurements. Data were obtained before RM, during RM, and at each PEEP level.
At the first trial, RM followed by PEEP of 15 cmH2O improved PaO2 in all patients (Fig. 1). On decreasing the PEEP from 15 to 0 cmH2O, PaO2 decreased from 470 ± 83 to225 ± 101 torr (P < 0.01). Although the mean blood pressure decreased and the mean pulmonary artery pressure increased (86 ± 8 to 57 ± 11 and 32 ± 9 to 36 ± 9 mmHg, respectively; P < 0.01) during RM, these returned to the baseline level when the PEEP was decreased to the baseline level. At the second trial, baseline PaO2 improved to 472 ± 84 torr and decreasing the PEEP resulted in a smaller decrease in PaO2 (to 360 ± 143 torr) than that at the first trial (P < 0.01).
RM improved oxygenation in all patients with hypoxemia after PTE for CPTE. In the early postoperative period oxygenation was highly dependent on PEEP, but this PEEP dependency became less apparent in the later period. RM suppressed circulation temporarily, but no adverse events sustained.
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Takeuchi, M., Imanaka, H., Tachibana, K. et al. Effects of recruitment maneuver and positive end-expiratory pressure on hypoxemia after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism. Crit Care 8, P27 (2004). https://doi.org/10.1186/cc2494
- Pulmonary Artery
- Postoperative Period
- Baseline Level
- Pressure Control
- Pulmonary Artery Pressure