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01-02-2003 | Original

Lung computed tomography during a lung recruitment maneuver in patients with acute lung injury

Authors: Guillermo Bugedo, Alejandro Bruhn, Glenn Hernández, Gonzalo Rojas, Cristián Varela, Juan Carlos Tapia, Luis Castillo

Published in: Intensive Care Medicine | Issue 2/2003

Abstract

Objective

To assess the acute effect of a lung recruitment maneuver (LRM) on lung morphology in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).

Patients

Ten patients with ALI/ARDS on mechanical ventilation.

Design

Prospective clinical study.

Setting

Computed tomography (CT) scan facility in a teaching hospital.

Interventions

An LRM performed by stepwise increases in positive end-expiratory pressure (PEEP) of up to 30–40 cmH₂O. Lung basal CT sections were taken at end-expiration (patients 1 to 5), and at end-expiration and end-inspiration (patients 6 to10). Arterial blood gases and static compliance (C_st) were measured before, during and after the LRM.

Measurements and main results

Poorly aerated and non-aerated tissue at PEEP 10 cmH₂O accounted for 60.0±29.1% of lung parenchyma, while only 1.1±1.8% was hyperinflated. Increasing PEEP to 20 and 30 cmH₂O, compared to PEEP 10 cmH₂O, decreased poorly aerated and non-aerated tissue by 16.2±28.0% and 33.4±13.8%, respectively (p<0.05). This was associated with an increase in PaO₂ and a decrease in total static compliance. Inspiration increased alveolar recruitment at all PEEP levels. Hyperinflated tissue increased up to 2.9±4.0% with PEEP 30 cmH₂O, and to a lesser degree with inspiration. No barotrauma or severe hypotension occurred.

Conclusions

Lung recruitment maneuvers improve oxygenation by expanding collapsed alveoli without inducing too much hyperinflation in ALI/ARDS patients. An LRM during the CT scan gives morphologic and functional information that could be useful in setting ventilatory parameters.

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Title: Lung computed tomography during a lung recruitment maneuver in patients with acute lung injury
Authors: Guillermo Bugedo
Alejandro Bruhn
Glenn Hernández
Gonzalo Rojas
Cristián Varela
Juan Carlos Tapia
Luis Castillo
Publication date: 01-02-2003
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 2/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-002-1618-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lung computed tomography during a lung recruitment maneuver in patients with acute lung injury

Abstract

Objective

Patients

Design

Setting

Interventions

Measurements and main results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Patients

Design

Setting

Interventions

Measurements and main results

Conclusions

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