[Comparative study on recruitment maneuvers in acute respiratory distress syndrome with pulmonary and extrapulmonary...

To study the effects of lung recruitment maneuvers (RM) in acute respiratory distress syndrome (ARDS) with pulmonary and extrapulmonary origin (ARDSp/ARDSexp).

Thirty-seven ARDS patients with a forced expiratory volume were selected (16 with ARDSp, 21 with ARDSexp). Without using any sedative and neuromuscular blocking agents, with continuous positive airway pressure (CPAP) up to 30 cm H(2)O (1 cm H(2)O=0.098 kPa), the patients were asked to hold the breath for 30 seconds, and then CPAP was lowered to the level of that before the treatment within 5-10 seconds.

Compared with the state before recruitment, changes in heart rate (HR) were not obvious in two groups during RM, mean arterial pressure was elevated evidently after 2 minutes in two groups (both P<0.05), and central venous pressure (CVP) rose after 30 seconds in two groups (both P<0.05). Peak inspiratory pressure, platform pressure and mean airway pressure increased clearly after 30 seconds (all P<0.05), and pulmonary compliance decreased obviously 30 seconds after re-inflation recruitment in two groups (both P<0.05), and increased obviously in ARDSexp group 5, 15, 30 minutes after recruitment (all P<0.05). In the group with ARDSp oxygenation index (OI) changed distinctly 10, 30 minutes and 1 hour after recruitment compared with the state before recruitment (all P<0.05). In patients with ARDSexp OI was significantly improved 10 minutes, 30 minutes, 1 hour, 2 hours after RM.

In ARDSexp, with pulmonary interstitial edema as the main pathology, responded better to RM than ARDSp with pulmonary consolidation.