Lung recruitment can improve oxygenation in patients ventilated in continuous positive airway pressure/pressure support mode

András Lovas, Márton Ferenc Németh, Domonkos Trásy, Z. Molnár

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Recruitment maneuvers are often used in critical care patients with hypoxemic respiratory failure. Although continuous positive airway pressure/pressure support (CPAP/PS) ventilation is a frequently used approach, but whether lung recruitment also improves oxygenation in spontaneously breathing patients has not been investigated yet. The primary objective was to analyze the effect of recruitment maneuver on oxygenation in patients ventilated in CPAP/PS mode. Methods: Following baseline measurements PEEP was increased by 5 cmH 2 O. Recruitment maneuver was applied for 40 s with 40 cmH 2 O of PS. Measurements of the difference in PaO 2 /FiO 2 and airway parameters measured by the ventilator were recorded immediately after recruitment then 15 and 30 min later. Thirty patients ventilated in CPAP/PS mode with a PEEP ≥5 cmH 2 O were enrolled in this prospective, observational study if their PaO 2 /FiO 2 ratio was < 300 mmHg or required an FiO 2 > 0.5. Results: Following recruitment maneuver patients were considered as non-responders (NR, n = 15) if difference of PaO 2 /FiO 2 < 20% and responders (R, n = 15) if difference of PaO 2 /FiO 2 ≥20%. In the NR-group, PaO 2 /FiO 2 decreased non-significantly from baseline: median [interquartile], PaO 2 /FiO 2 = 176 [120-186] vs. after recruitment: 169 [121-182] mmHg, P = 0.307 while in the R-group there was significant improvement: 139 [117-164] vs. 230 [211-323] mmHg, P = 0.01. At the same time points, dead space to tidal volume ratio (Vds/Vte) significantly increased in the NR-group Vds/Vte = 32 [27-37] vs. 36 [25-42]%, P = 0.013 but no significant change was observed in the R-group: 26 [22-34] vs. 27 [24-33]%, P = 0.386. Conclusion: Recruitment maneuver improved PaO 2 /FiO 2 ratio by ≥20% in 50% of patients ventilated in CPAP/PS mode.

Original languageEnglish
Article number25
JournalFrontiers in Medicine
Volume2
Issue numberAPR
DOIs
Publication statusPublished - Jan 1 2015

Fingerprint

Continuous Positive Airway Pressure
Pressure
Lung
Tidal Volume
Mechanical Ventilators
Critical Care
Respiratory Insufficiency
Patient Selection
Observational Studies
Ventilation
Respiration
Prospective Studies

Keywords

  • Capnography
  • CPAP ventilation
  • Lung compliance
  • Lung recruitment
  • Positive end-expiratory pressure

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lung recruitment can improve oxygenation in patients ventilated in continuous positive airway pressure/pressure support mode. / Lovas, András; Németh, Márton Ferenc; Trásy, Domonkos; Molnár, Z.

In: Frontiers in Medicine, Vol. 2, No. APR, 25, 01.01.2015.

Research output: Contribution to journalArticle

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abstract = "Background: Recruitment maneuvers are often used in critical care patients with hypoxemic respiratory failure. Although continuous positive airway pressure/pressure support (CPAP/PS) ventilation is a frequently used approach, but whether lung recruitment also improves oxygenation in spontaneously breathing patients has not been investigated yet. The primary objective was to analyze the effect of recruitment maneuver on oxygenation in patients ventilated in CPAP/PS mode. Methods: Following baseline measurements PEEP was increased by 5 cmH 2 O. Recruitment maneuver was applied for 40 s with 40 cmH 2 O of PS. Measurements of the difference in PaO 2 /FiO 2 and airway parameters measured by the ventilator were recorded immediately after recruitment then 15 and 30 min later. Thirty patients ventilated in CPAP/PS mode with a PEEP ≥5 cmH 2 O were enrolled in this prospective, observational study if their PaO 2 /FiO 2 ratio was < 300 mmHg or required an FiO 2 > 0.5. Results: Following recruitment maneuver patients were considered as non-responders (NR, n = 15) if difference of PaO 2 /FiO 2 < 20{\%} and responders (R, n = 15) if difference of PaO 2 /FiO 2 ≥20{\%}. In the NR-group, PaO 2 /FiO 2 decreased non-significantly from baseline: median [interquartile], PaO 2 /FiO 2 = 176 [120-186] vs. after recruitment: 169 [121-182] mmHg, P = 0.307 while in the R-group there was significant improvement: 139 [117-164] vs. 230 [211-323] mmHg, P = 0.01. At the same time points, dead space to tidal volume ratio (Vds/Vte) significantly increased in the NR-group Vds/Vte = 32 [27-37] vs. 36 [25-42]{\%}, P = 0.013 but no significant change was observed in the R-group: 26 [22-34] vs. 27 [24-33]{\%}, P = 0.386. Conclusion: Recruitment maneuver improved PaO 2 /FiO 2 ratio by ≥20{\%} in 50{\%} of patients ventilated in CPAP/PS mode.",
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AU - Németh, Márton Ferenc

AU - Trásy, Domonkos

AU - Molnár, Z.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Recruitment maneuvers are often used in critical care patients with hypoxemic respiratory failure. Although continuous positive airway pressure/pressure support (CPAP/PS) ventilation is a frequently used approach, but whether lung recruitment also improves oxygenation in spontaneously breathing patients has not been investigated yet. The primary objective was to analyze the effect of recruitment maneuver on oxygenation in patients ventilated in CPAP/PS mode. Methods: Following baseline measurements PEEP was increased by 5 cmH 2 O. Recruitment maneuver was applied for 40 s with 40 cmH 2 O of PS. Measurements of the difference in PaO 2 /FiO 2 and airway parameters measured by the ventilator were recorded immediately after recruitment then 15 and 30 min later. Thirty patients ventilated in CPAP/PS mode with a PEEP ≥5 cmH 2 O were enrolled in this prospective, observational study if their PaO 2 /FiO 2 ratio was < 300 mmHg or required an FiO 2 > 0.5. Results: Following recruitment maneuver patients were considered as non-responders (NR, n = 15) if difference of PaO 2 /FiO 2 < 20% and responders (R, n = 15) if difference of PaO 2 /FiO 2 ≥20%. In the NR-group, PaO 2 /FiO 2 decreased non-significantly from baseline: median [interquartile], PaO 2 /FiO 2 = 176 [120-186] vs. after recruitment: 169 [121-182] mmHg, P = 0.307 while in the R-group there was significant improvement: 139 [117-164] vs. 230 [211-323] mmHg, P = 0.01. At the same time points, dead space to tidal volume ratio (Vds/Vte) significantly increased in the NR-group Vds/Vte = 32 [27-37] vs. 36 [25-42]%, P = 0.013 but no significant change was observed in the R-group: 26 [22-34] vs. 27 [24-33]%, P = 0.386. Conclusion: Recruitment maneuver improved PaO 2 /FiO 2 ratio by ≥20% in 50% of patients ventilated in CPAP/PS mode.

AB - Background: Recruitment maneuvers are often used in critical care patients with hypoxemic respiratory failure. Although continuous positive airway pressure/pressure support (CPAP/PS) ventilation is a frequently used approach, but whether lung recruitment also improves oxygenation in spontaneously breathing patients has not been investigated yet. The primary objective was to analyze the effect of recruitment maneuver on oxygenation in patients ventilated in CPAP/PS mode. Methods: Following baseline measurements PEEP was increased by 5 cmH 2 O. Recruitment maneuver was applied for 40 s with 40 cmH 2 O of PS. Measurements of the difference in PaO 2 /FiO 2 and airway parameters measured by the ventilator were recorded immediately after recruitment then 15 and 30 min later. Thirty patients ventilated in CPAP/PS mode with a PEEP ≥5 cmH 2 O were enrolled in this prospective, observational study if their PaO 2 /FiO 2 ratio was < 300 mmHg or required an FiO 2 > 0.5. Results: Following recruitment maneuver patients were considered as non-responders (NR, n = 15) if difference of PaO 2 /FiO 2 < 20% and responders (R, n = 15) if difference of PaO 2 /FiO 2 ≥20%. In the NR-group, PaO 2 /FiO 2 decreased non-significantly from baseline: median [interquartile], PaO 2 /FiO 2 = 176 [120-186] vs. after recruitment: 169 [121-182] mmHg, P = 0.307 while in the R-group there was significant improvement: 139 [117-164] vs. 230 [211-323] mmHg, P = 0.01. At the same time points, dead space to tidal volume ratio (Vds/Vte) significantly increased in the NR-group Vds/Vte = 32 [27-37] vs. 36 [25-42]%, P = 0.013 but no significant change was observed in the R-group: 26 [22-34] vs. 27 [24-33]%, P = 0.386. Conclusion: Recruitment maneuver improved PaO 2 /FiO 2 ratio by ≥20% in 50% of patients ventilated in CPAP/PS mode.

KW - Capnography

KW - CPAP ventilation

KW - Lung compliance

KW - Lung recruitment

KW - Positive end-expiratory pressure

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