Effects of Stepwise Lung Recruitment Maneuvers in Patients with Early Acute Respiratory Distress Syndrome: A Prospective, Randomized, Controlled Trial.

Shu-Chen Kung,Yi-Li Hung,Wei-Lun Liu,Hui-Chun Chang,Ching-Min Wang,Wan-Ling Chen

doi:10.3390/jcm8020231

Abstract

Since the clinical benefit of lung recruitment maneuvers (LRMs) is still conflicting, we performed this prospective, randomized, controlled study to investigate whether LRMs should be used in the routine management of acute respiratory distress syndrome (ARDS). This trial was conducted in four intensive care units (ICUs) to compare application of a modified stepwise LRMs with solely lung-protective ventilation in patients with moderate to severe ARDS within 72 h from the onset. The primary outcome was 28-day mortality, and the secondary outcomes were ventilator-free days and ICU-free days. We collected data on 120 ARDS patients from 2009 to 2012, and there was no difference in 28-day mortality between the two groups (28.3% vs. 30.0%, p = 0.84). However, among survivors, patients in the LRM group had a significant longer median duration of ventilator-free days (18 vs. 13 days; p = 0.04) and ICU-free days (16 vs. 11 days; p = 0.03) at 28 days than in the control group. The respiratory system compliance was significantly higher in the LRM group from day 1 to day 7. The occurrence rate of barotrauma was similar in both groups. We concluded that LRMs combined with lung-protective ventilation in early ARDS may improve patient outcomes.

Highlights

Acute respiratory distress syndrome (ARDS) is a hypoxic, non-homogeneous pulmonary disease characterized by focal atelectasis, focal emphysema, and intrapulmonary shunting [1,2]
Patients admitted to the intensive care units (ICUs) who met the criteria for acute respiratory distress syndrome (ARDS) using the American–European Consensus Conference definition [2], who were on mechanical ventilation for
All patients received sedatives prior to the recruitment maneuvers and 52 patients (86.7%) received neuromuscular-blocking agents in lung recruitment maneuvers (LRMs) groups compared with 24 patients (40%) in the control group (p < 0.001)

Summary

Introduction

Acute respiratory distress syndrome (ARDS) is a hypoxic, non-homogeneous pulmonary disease characterized by focal atelectasis, focal emphysema, and intrapulmonary shunting [1,2]. Small tidal volume ventilation can decrease lung damage caused by shearing forces and benefit ARDS patients in terms of mortality and ventilator-free days [4]. This strategy has become the standard lung-protective ventilation strategy in ARDS. Lung recruitment may improve hypoxemia by opening the collapsed lung and decreasing the intrapulmonary shunt (ventilation/perfusion mismatch) [1,6]

Methods

Results

Conclusion