Intercomparison of three recruitment maneuvers in acute respiratory distress syndrome: the role of Body Mass Index Full Text
Minerva Anestesiologica, 06/14/2012
Katsiari M et al. – In the cohort, recruitment by two sustained inflations resulted in a more persistent improvement of oxygenation as compared with recruitment by pressure controlled ventilation or consecutive sighs with the same airway pressure. Body mass index (BMI) seems to have an impact on recruitment maneuvers (RMs) effectiveness, most probably by altering the effective transpulmonary pressure.Methods
- This was a prospective clinical trial conducted in a general intensive care unit.
- In 25 consecutive early ARDS patients arterial blood gases, respiratory system elastance (Est,rs) and hemodynamics were monitored before (T0), and at 3, 15, and 30min (T3, T15, T30, respectively) after each of three different RMs techniques with same airway pressures (45cmH2O), randomly applied in each patient; RM–1: pressure control ventilation for 1min, RM–2: two hyperinflations with continuous positive airway pressure for 20sec and 1min interval in between, RM–3: three consecutive sighs.
- All RMs improved oxygenation and Est,rs shortly (T3) after their application, but only RM–2 had a prolonged beneficial effect on oxygenation (T30).
- Patients were further divided according to their BMI: in the low BMI group (<27.3Kg/m2) the effectiveness of RMs was similar to the whole study population, while in the high BMI group (≥27.3Kg/m2) no sustained effect followed any RM.