Optimal duration of a sustained inflation recruitment maneuver in ARDS patients

Abstract

To measure the dynamics of recruitment and the hemodynamic status during a sustained inflation recruitment maneuver (RM) in order to determine the optimal duration of RM in acute respiratory distress syndrome (ARDS) patients. This prospective study was conducted in a 12-bed intensive care unit (ICU) in a general hospital. A 40cmH(2)O sustained inflation RM maintained for 30s was performed in 50 sedated ventilated patients within the first 24h of meeting ARDS criteria. Invasive arterial pressures, heart rate, and SpO(2) were measured at 10-s intervals during the RM. The volume increase during the RM was measured by integration of the flow required to maintain the pressure at 40cmH(2)O, which provides an estimation of the volume recruited during the RM. Raw data were corrected for gas consumption and fitted with an exponential curve in order to determine an individual time constant for the volume increase. The average volume increase and time constant were 210±198mL and 2.3±1.3s, respectively. Heart rate, diastolic arterial pressure, and SpO(2) did not change during or after the RM. Systolic and mean arterial pressures were maintained at 10s, decreased significantly at 20 and 30s during the RM, and recovered to the pre-RM value 30s after the end of the RM (ANOVA, p<0.01). In early-onset ARDS patients, most of the recruitment occurs during the first 10s of a sustained inflation RM. However, hemodynamic impairment is significant after the tenth second of RM.