Alveolar recruitment maneuver in patients with subarachnoid hemorrhage and acute respiratory distress syndrome: A comparison of 2 approaches

• Published in: Journal of critical care Vol. 26; no. 1; pp. 22 - 27
• Main Authors: Nemer, Sérgio N., RT, PhD, Caldeira, Jefferson B., RT, MsC, Azeredo, Leandro M., RT, MsC, Garcia, João Márcio, MD, PhD, Silva, Ricardo T., MD, Prado, Darwin, MD, Santos, Ricardo G., RT, Guimarães, Bruno S., RT, Ramos, Rodrigo A., RT, Noé, Rosângela A., MsC, Souza, Paulo Cesar P., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2011; Elsevier Limited
• Subjects: Acute respiratory distress syndrome; Aged; Brain damage; Brain Injuries - therapy; Brain injury; Cerebrovascular Circulation; Continuous Positive Airway Pressure - methods; Critical Care; Heart rate; Humans; Hypertension; Intracranial Pressure; Lungs; Mechanical ventilation; Mortality; Oxygen - administration & dosage; Oxygen - blood; Positive-Pressure Respiration - methods; Pulmonary Alveoli - physiopathology; Respiration, Artificial; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - complications; Respiratory Distress Syndrome, Adult - therapy; Studies; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - therapy; Treatment Outcome; Ventilation; Brazil; Acute respiratory distress syndrome; Mechanical ventilation; Brain injury
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2010.04.015

Abstract Purpose The purpose of the study was to compare 2 alveolar recruitment maneuvers (ARMs) approaches in patients with subarachnoid hemorrhage (SAH) and acute respiratory distress syndrome (ARDS). Material and Methods Sixteen SAH patients with ARDS were randomized in 2 similar groups. One received ARM with continuous positive airway pressure (CPAP) of 35 cm H2 O for 40 seconds (CPAP recruitment), whereas the other received pressure control ventilation with positive-end expiratory pressure of 15 cm H2 O and pressure control above positive end-expiratory pressure of 35 cm H2 O for 2 minutes (pressure control recruitment maneuver [PCRM]). Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were measured before and after ARM. The ratio of arterial oxygen tension to fraction of inspired oxygen was measured before and 1 hour after the ARM. Results After ARM, ICP was higher in CPAP recruitment (20.50 ± 4.75 vs 13.13 ± 3.56 mm Hg; P = .003); and CPP was lower in CPAP recruitment (62.38 ± 9.81 vs 79.60 ± 6.8 mm Hg; P = .001). One hour after the ARM, the ratio of arterial oxygen tension to fraction of inspired oxygen increased significantly only in PCRM (108.5 to 203.6; P = .0078). Conclusion In SAH patients with ARDS, PCRM did not affect ICP and decreased CPP in safe levels, besides improving oxygenation.