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Efficacy and safety of recruitment maneuvers in acute respiratory distress syndrome.doc

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Efficacy and safety of recruitment maneuvers in acute respiratory distress syndrome

Guerinetal.AnnalsofIntensiveCare2011,1:9 /content/1/1/9 REVIEW OpenAccess Efficacyandsafetyofrecruitmentmaneuversin acuterespiratorydistresssyndrome ClaudeGuerin*,SophieDebord,VéroniqueLeray,BertrandDelannoy,FrédériqueBayle,GaelBourdinand Jean-ChristopheRichard Abstract Recruitmentmaneuvers(RM)consistofaventilatorystrategythatincreasesthetranspulmonarypressuretransiently toreopentherecruitablelungunitsinacuterespiratorydistresssyndrome(ARDS).TherationalestouseRMin ARDSarethatthereisamassivelossofaeratedlungandthatoncetheend-inspiratorypressuresurpassesthe regionalcriticalopeningpressureofthelungunits,thoseunitsarelikelytoreopen.Therearedifferentmethodsto performRMwhenusingtheconventionalICUventilator.ThethreeRMmethodsthataremostlyusedand investigatedaresighs,sustainedinflation,andextendedsigh.ThereisnostandardizationofanyoftheaboveRM. Meta-analysisrecommendednottouseRMinroutineinstableARDSpatientsbuttorunthemincaseoflife- threateninghypoxemia.TherearesomeconcernsregardingthesafetyofRMintermsofhemodynamics preservationandlunginjuryaswell.Therapidrisinginpressurecanbeafactorthatexplainsthepotentialharmful effectsoftheRM.Inthisreview,wedescribethebalancebetweenthebeneficialeffectsandtheharmful consequencesofRM.Recentanimalstudiesarediscussed. Definition used lung computed tomography (CT) scan [1-3]. Recruitmentmaneuvers(RM)canbedefinedasavolun- Alveolarcollapse(i.e.,atelectasis)resultsfromincreased tary strategy to increase the transpulmonary pressure interstitialpressureandweightofthelung(spongethe- (PL) transiently with the goal to reopen those alveolar ory).Itcanbeenhancedbypatient-relatedfactors,such unitsthatarenotaeratedorpoorlyaeratedbutreopen- as obesity, increased intra-abdominal pressure, high able. The consequence of this should be the induction levelsofinspiredoxygeninunstablealveoli,patientdis- of lung recruitment. This strategy can be performed connectionfromtheventilator,ortrachealsuctioning.It by using the conventional ICU ventilator