Maximal recruitment strategy guided by thoracic computed tomography scan in acute respiratory distress syndrome patients: preliminary results of a clinical study

Introduction

There is great controversy concerning protective ventilatory strategy in ARDS. Recruitment maneuvers and PEEP titration sufficient to avoid collapse and tidal recruitment in the lung are the major goals of the maximal recruitment strategy (MRS) guided by computed tomography (CT).

Objectives

To evaluate the gas exchange response before and after MRS. To describe the ventilator parameters set by CT image. To describe patient characteristics at entry and the 7-day SOFA score evolution after PEEP titration. To evaluate possible complications related to transportations and barotrauma.

Methods

Forty-five patients with the diagnosis of ARDS were transported to the CT room and submitted to the MRS, which consisted of 2-min steps of tidal ventilation with a fixed ΔPCV of 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 image, and were used to ventilate the patients afterward. PEEP was maintained as set by CT for 48 hours.

Results

Clinical and laboratory data are presented in Table 1. There were no complications due to transportation to the CT room, and no barotrauma was detected.

Table 1

Conclusion

MRS was well tolerated in this series of patients, rendering the gas distribution through the lung more homogeneous, improving gas exchange and being related to low mortality. A RCT to compare MRS with the strategy proposed by the ARDSNet investigators is necessary.