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01.07.2011 | Original

Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure

verfasst von: Gianmaria Cammarota, Rosanna Vaschetto, Emilia Turucz, Fabrizio Dellapiazza, Davide Colombo, Cristiana Blando, Francesco Della Corte, Salvatore Maurizio Maggiore, Paolo Navalesi

Erschienen in: Intensive Care Medicine | Ausgabe 7/2011

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Abstract

Purpose

Noninvasive continuous positive airway pressure (n-CPAP) has been proposed for the treatment of hypoxemic acute respiratory failure (h-ARF). Recruitment maneuvers were shown to improve oxygenation, i.e., the ratio of arterial oxygen tension to inspiratory oxygen fraction (PaO₂/FiO₂), during either invasive mechanical ventilation, and n-CPAP, with a response depending on the distribution of lung collapse. We hypothesized that, during n-CPAP, early h-ARF patients with bilateral (B_L) distribution of lung involvement would benefit from recruitment maneuvers more than those with unilateral (U_L) involvement.

Methods

To perform a recruitment maneuver, once a minute we increased the pressure applied to the airway from 10 cmH₂O to 25 cmH₂O for 8 s (SIGH). We enrolled 24 patients with h-ARF (12 B_L and 12 U_L) who underwent four consecutive trials: (1) 30 min breathing through a Venturi mask (V_MASK), (2) 1 h n-CPAP (n-CPAP₁), (3) 1 h n-CPAP plus SIGH (n-CPAP_SIGH), and (4) 1 h n-CPAP (n-CPAP₂).

Results

Compared to V_MASK, n-CPAP at 10 cmH₂O delivered via a helmet, increased PaO₂/FiO₂ and decreased dyspnea in both B_L and U_L; furthermore, it reduced the respiratory rate and brought PaCO₂ up to normal in B_L only. Compared to n-CPAP, n-CPAP_SIGH significantly improved PaO₂/FiO₂ in B_L (225 ± 88 vs. 308 ± 105, respectively), whereas it produced no further improvement in PaO₂/FiO₂ in U_L (232 ± 72 vs. 231 ± 77, respectively). SIGH did not affect hemodynamics in both groups.

Conclusions

Compared to n-CPAP, n-CPAP_SIGH further improved arterial oxygenation in B_L patients, whereas it produced no additional benefit in those with U_L.

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Titel: Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure
verfasst von: Gianmaria Cammarota
Rosanna Vaschetto
Emilia Turucz
Fabrizio Dellapiazza
Davide Colombo
Cristiana Blando
Francesco Della Corte
Salvatore Maurizio Maggiore
Paolo Navalesi
Publikationsdatum: 01.07.2011
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 7/2011
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-011-2239-8

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Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure