Abstract
IntroductionTracheal intubation and anaesthesia promotes lung collapse and hypoxemia. In acute lung injury patients, recruitment maneuvers (RMs) increase lung volume and oxygenation, and decrease atelectasis. The aim of this study was to evaluate the efficacy and safety of RMs performed immediately after intubation.MethodsThis randomized controlled study was conducted in two 16-bed medical-surgical intensive care units within the same university hospital. Consecutive patients requiring intubation for acute hypoxemic respiratory failure were included. Patients were randomized to undergo a RM immediately (within 2 minutes) after intubation, consisting of a continuous positive airway pressure (CPAP) of 40 cmH2O over 30 seconds (RM group), or not (control group). Blood gases were sampled and blood samples taken for culture before, within 2 minutes, 5 minutes, and 30 minutes after intubation. Haemodynamic and respiratory parameters were continuously recorded throughout the study. Positive end expiratory pressure (PEEP) was set at 5 cmH2O throughout.ResultsThe control (n = 20) and RM (n = 20) groups were similar in terms of age, disease severity, diagnosis at time of admission, and PaO2 obtained under 10-15 L/min oxygen flow immediately before (81 ± 15 vs 83 ± 35 mmHg, P = 0.9), and within 2 minutes after, intubation under 100% FiO2 (81 ± 15 vs 83 ± 35 mmHg, P = 0.9). Five minutes after intubation, PaO2 obtained under 100% FiO2 was significantly higher in the RM group compared with the control group (93 ± 36 vs 236 ± 117 mmHg, P = 0.008). The difference remained significant at 30 minutes with 110 ± 39 and 180 ± 79 mmHg, respectively, for the control and RM groups. No significant difference in haemodynamic conditions was observed between groups at any time. Following tracheal intubation, 15 patients had positive blood cultures, showing microorganisms shared with tracheal aspirates, with no significant difference in the incidence of culture positivity between groups.ConclusionsRecruitment maneuver following intubation in hypoxemic patients improved short-term oxygenation, and was not associated with increased adverse effects.Trial registrationNCT01014299
Highlights
Tracheal intubation and anaesthesia promotes lung collapse and hypoxemia
Study population Adult patients were recruited in two medicosurgical ICUs of the same French University hospital of Clermont-Ferrand and were considered eligible if they met two criteria: acute hypoxemic respiratory failure requiring intubation; and hypoxemia, defined as a partial pressure of arterial oxygen (PaO2) less than 100 mmHg under a high fraction of inspired oxygen (FiO2) mask driven by at least 10 L/min oxygen [8]
The baseline characteristics of the two groups were similar in terms of age, disease severity, organ failure, and diagnosis on admission (Table 1)
Summary
In acute lung injury patients, recruitment maneuvers (RMs) increase lung volume and oxygenation, and decrease atelectasis. Lation applied to a collapsed and/or infected lung increases the risk of ventilator-induced lung injury [6,7]. Baillard and colleagues have recently shown that preoxygenation with non-invasive ventilation (NIV) is more effective at reducing arterial oxyhemoglobin desaturation after intubation than the usual method [8]. Recruitment manoeuvres (RMs), which consist of transient increases in inspiratory pressure [9,10], reduce anesthesia-induced lung collapse and hypoxemia [11]. During early acute respiratory failure, RMs increase oxygenation and lung volume, and may reduce lung edema [9,12]. No study has evaluated the short-term effect of a RM performed early after intubation in critically ill patients
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