Alveolar recruitment maneuver attenuates extravascular lung water in acute respiratory distress syndrome

Fu-Tsai Chung, Chung-Shu Lee, Shu-Min Lin, Chih-Hsi Kuo, Tsai-Yu Wang, Yueh-Fu Fang, Meng-Heng Hsieh, Hao-Cheng Chen, Horng-Chyuan Lin, Fu-Tsai Chung, Chung-Shu Lee, Shu-Min Lin, Chih-Hsi Kuo, Tsai-Yu Wang, Yueh-Fu Fang, Meng-Heng Hsieh, Hao-Cheng Chen, Horng-Chyuan Lin

Abstract

Background: The alveolar recruitment maneuver (RM) has been reported to improve oxygenation in acute respiratory distress syndrome (ARDS) and may be related to reduced extravascular lung water (EVLW) in animals. This study was designed to investigate the effects of RM on EVLW in patients with ARDS.

Methods: An open label, prospective, randomized controlled trial including patients with ARDS was conducted in hospitals in North Taiwan between 2010 and 2016. The patients were divided into 2 groups (with and without RM). The primary endpoint was the comparison of the EVLW index between the 2 groups.

Results: Twenty-four patients with ARDS on mechanical ventilator support were randomized to receive ventilator treatment with RM (RM group, n = 12) or without RM (non-RM group, n = 12). Baseline demographic characteristics were similar between the 2 groups. After recruitment, the day 3 extravascular lung water index (EVLWI) (25.3 ± 9.3 vs 15.5 ± 7.3 mL/kg, P = .008) and the arterial oxygen tension/fractional inspired oxygen ratio (PaO2/FiO2) (132.3 ± 43.5 vs 185.6 ± 38.8 mL/kg, P = .003) both improved over that of day 1. However, both EVLWI and PaO2/FiO2 did not significantly change from day 1 to 3 in the non-RM group.

Conclusion: RM is a feasible method for improving oxygenation and the EVLW index in patients with ARDS, as well as for decreasing ventilator days and intensive care unit stay duration.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Overview of the included patients.
Figure 2
Figure 2
(A) Changes in EVLWI from day 1 to day 7 between the RM and non-RM groups. EVLWI decreased in the RM group, but not in the non-RM group. This was significantly different (P = .003, 2-way ANOVA, data presented as means with standard error). (B) Changes in PaO2/FiO2 from day 1 to day 7 between the RM and non-RM groups. PaO2/FiO2 improved in the RM group, but not in the non-RM group. This was significantly different (P = .02, 2-way ANOVA, data presented as means ± standard error). ANOVA = analysis of variance, EVLWI = extravascular lung water index, PaO2/FiO2 = arterial oxygen tension/fractional inspired oxygen ratio, PBW = predicted body weight, PEEP = positive end-expiratory pressure, PICCO = pulse contour continuous cardiac output, RM = recruitment maneuver.
Figure 3
Figure 3
(A) Changes in EVLWI between day 1 and day 3 in the RM and non-RM groups. In the RM group, the EVLWI on day 3 was improved over that of day 1 (25.3 ± 9.3 vs 15.5 ± 7.3 mL/kg, P = .008, by the t test). In the non-RM group, EVLWI on day 3 remained unchanged when compared to that of day 1 (27.0 ± 5.5 vs 23.5 ± 5.5 mL/kg, P = .23, by the t test). (B) Changes in PaO2/FiO2 between day 1 and day 3 in the RM and non-RM groups. In the RM group, the PaO2/FiO2 on day 3 was improved over that of day 1 (132.3 ± 43.5 vs 185.6 ± 38.8 mL/kg, P = .003, by the t test). In the non-RM group, the EVLWI on day 3 did not change relative to that of day 1 (140.5 ± 47.1 vs 146.7 ± 39.1 mL/kg, P = .73, by the t test). EVLWI = extravascular lung water index, PaO2/FiO2 = arterial oxygen tension/fractional inspired oxygen ratio, RM = recruitment maneuver.

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Source: PubMed

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