Recruitment maneuver for escape oxygenation in acute respiratory distress syndrome

Abstract

Introduction: Although acute respiratory distress syndrome (ARDS) has been focus of attention of all intensive care practitioners for decades, many issues regarding mechanical ventilation, the cornerstone of the treatment, have not yet been clarified. Recruitment maneuver (RM) has been used within initial 7 days of treatment, in order to expand collapsed alveoli, determine the optimum values of PEEP and improve oxygenation. The intervention is not standardized; it is still not clear if various protocols have any difference in clinical effects and outcome. However, since hypoxemia in patients with ARDS may be very severe and life threatening, RM can be used to improve oxygenation. Case report: Here, we present the patient suffering from aortic dissection Type 3 (DeBakey classification) and severe ARDS due to aspiration of gastric contents. The patient was ventilated with volume controlled mechanical ventilation, with low tidal volumes and different values of PEEP. In order to improve oxygenation (rescue oxygenation) and to determine the optimal value of PEEP, staircase RM has been applied successfully. Improved oxygenation during critical phases of illness may have contributed to the overall favorable outcome. Conclusion: In patients with ARDS, various interventions may be used to correct severe hypoxemia. Staircase recruitment maneuver may be used as a part of mechanical ventilation strategy, in order to improve oxygenation and define optimal PEEP for selected patients.