Maximal recruitment strategy guided by thoracic CT scan in severe acute respiratory distress syndrome patients: a case series report

Introduction

There is great controversy concerning protective ventilation in ARDS. Recruitment maneuvers and PEEP titration sufficient to avoid collapse and tidal recruitment are the major goals of the maximal recruitment strategy (MRS).

Objectives

To describe clinical and demographic data. To evaluate the incidence of complications related to transportation and to the MRS.

Methods

Forty-three patients with ARDS were transported to CT and submitted to the MRS, which consisted of 2-minute steps of ventilation with a fixed PCV = 15 cmH₂O and progressive PEEP levels (10-45-25-10 cmH₂O), RR = 10, I:E = 1:1, and FiO₂ = 1.0. Opening (recruitment) and closing (PEEP titration) pressures were determined according to the least amount of collapse observed at the CT, and were used to ventilate the patients afterwards.

Results

Clinical data are presented in Table 1. There were no complications due to transportation and one patient developed pneumomediatinum after the protocol.

Table 1 abstract P188

Conclusion

MRS was well tolerated in this series of patients, rendered the gas distribution through the lung more homogeneous, improved gas exchange and was related to low mortality. A RCT to test the MRS is necessary.