Recruitment maneuvers with different pressure control levels in ARDS patients

Background and objective

Respiratory system PxV curves and recruitment maneuvers can improve oxygenation and survival when compared to the conventional ventilation in ARDS patients.

Method

In order to study the effects of recruiting the respiratory system with either 40 cmH₂O plateau pressure or 60 cmH₂O plateau pressures after the PEEP was set 2 cmH₂O above the inflection point we studied 10 patients with ARDS criteria (less than 5 days of installation), with mean age of 66 ± 0.10 years and mean APACHE score of 21.8. After performing the PxV curve (random volumes) we set the PEEP 2 cmH₂O above the Pflex and ventilated the patients with 6 ml/kg TV and RR of 20. Then we randomly assigned the patients to two groups. Group 1: three cycles of PCV with maximal pressure of 40, 40, 40 cmH₂O for 6 s each; and Group 2: three cycles of PCV with maximal pressures of 40, 50 and 60 for 6 s each every 3 h during the first 24 h of mechanical ventilation. We measured the respiratory and hemodynamic parameters at baseline, after 1 and 6 h.

Results

See table.

Table

Conclusion

Recruitment maneuvers with PCV of 60 cmH₂O allowed a better oxygention compared to recruitment maneuver of PCV 40 mainly after 6 h in ARDS patients without hemodynamic impairments.