Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress Syndrome
Introduction. In acute respiratory distress syndrome (ARDS) the recruitment maneuver (RM) is used to reexpand atelectatic areas of the lungs aiming to improve arterial oxygenation. The goal of our paper was to evaluate the response to RM, as assessed by measurements of extravascular lung water index...
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Wiley
2012-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2012/606528 |
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| author | Alexey A. Smetkin Vsevolod V. Kuzkov Eugeny V. Suborov Lars J. Bjertnaes Mikhail Y. Kirov |
| author_facet | Alexey A. Smetkin Vsevolod V. Kuzkov Eugeny V. Suborov Lars J. Bjertnaes Mikhail Y. Kirov |
| author_sort | Alexey A. Smetkin |
| collection | DOAJ |
| description | Introduction. In acute respiratory distress syndrome (ARDS) the recruitment maneuver (RM) is used to reexpand atelectatic areas of the lungs aiming to improve arterial oxygenation. The goal of our paper was to evaluate the response to RM, as assessed by measurements of extravascular lung water index (EVLWI) in ARDS patients. Materials and Methods. Seventeen adult ARDS patients were enrolled into a prospective study. Patients received protective ventilation. The RM was performed by applying a continuous positive airway pressure of 40 cm H2O for 40 sec. The efficacy of the RM was assessed 5 min later. Patients were identified as responders if PaO2/FiO2 increased by >20% above the baseline. EVLWI was assessed by transpulmonary thermodilution before the RM, and patients were divided into groups of low EVLWI (<10 mL/kg) and high EVLWI (≥10 mL/kg). Results. EVLWI was increased in 12 patients. Following RM, PaO2/FiO2 increased by 33 (4–65) % in the patients with low EVLWI, whereas those in
the high EVLWI group experienced a change by only −1((−13)–(+5)) % (𝑃=0.035). Conclusion. In ARDS, the response to a recruitment maneuver might be related to the severity of pulmonary edema. In patients with incresed EVLWI, the recruitment maneuver is less effective. |
| format | Article |
| id | doaj-art-9d6b22e5f5714afabf8309b33ff0c010 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
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| series | Critical Care Research and Practice |
| spelling | doaj-art-9d6b22e5f5714afabf8309b33ff0c0102025-02-03T01:10:51ZengWileyCritical Care Research and Practice2090-13052090-13132012-01-01201210.1155/2012/606528606528Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress SyndromeAlexey A. Smetkin0Vsevolod V. Kuzkov1Eugeny V. Suborov2Lars J. Bjertnaes3Mikhail Y. Kirov4Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Avenue 51, Arkhangelsk 163000, RussiaDepartment of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Avenue 51, Arkhangelsk 163000, RussiaDepartment of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Avenue 51, Arkhangelsk 163000, RussiaDepartment of Clinical Medicine (Anesthesiology), Faculty of Health Sciences, University of Tromsø, MH-Breivika, Tromsø 9038, NorwayDepartment of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Avenue 51, Arkhangelsk 163000, RussiaIntroduction. In acute respiratory distress syndrome (ARDS) the recruitment maneuver (RM) is used to reexpand atelectatic areas of the lungs aiming to improve arterial oxygenation. The goal of our paper was to evaluate the response to RM, as assessed by measurements of extravascular lung water index (EVLWI) in ARDS patients. Materials and Methods. Seventeen adult ARDS patients were enrolled into a prospective study. Patients received protective ventilation. The RM was performed by applying a continuous positive airway pressure of 40 cm H2O for 40 sec. The efficacy of the RM was assessed 5 min later. Patients were identified as responders if PaO2/FiO2 increased by >20% above the baseline. EVLWI was assessed by transpulmonary thermodilution before the RM, and patients were divided into groups of low EVLWI (<10 mL/kg) and high EVLWI (≥10 mL/kg). Results. EVLWI was increased in 12 patients. Following RM, PaO2/FiO2 increased by 33 (4–65) % in the patients with low EVLWI, whereas those in the high EVLWI group experienced a change by only −1((−13)–(+5)) % (𝑃=0.035). Conclusion. In ARDS, the response to a recruitment maneuver might be related to the severity of pulmonary edema. In patients with incresed EVLWI, the recruitment maneuver is less effective.http://dx.doi.org/10.1155/2012/606528 |
| spellingShingle | Alexey A. Smetkin Vsevolod V. Kuzkov Eugeny V. Suborov Lars J. Bjertnaes Mikhail Y. Kirov Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress Syndrome Critical Care Research and Practice |
| title | Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress Syndrome |
| title_full | Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress Syndrome |
| title_fullStr | Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress Syndrome |
| title_full_unstemmed | Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress Syndrome |
| title_short | Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress Syndrome |
| title_sort | increased extravascular lung water reduces the efficacy of alveolar recruitment maneuver in acute respiratory distress syndrome |
| url | http://dx.doi.org/10.1155/2012/606528 |
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