Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS

Background:  To evaluate the effect of a recruitment maneuver (RM) with constant positive inspiratory pressure and high positive end-expiratory pressure (PEEP) on oxygenation and static compliance (Cs) in patients with severe acute respiratory distress syndrome (ARDS). Methods:  Eight patients with ARDS ventilated with lung-protective strategy and an arterial partial pressure of oxygen to inspired oxygen fraction ratio (PaO2/FIO2) ≤100 mmHg regardless of PEEP were prospectively studied. The RM was performed in pressure-controlled ventilation at FIO2 of 1.0 until PaO2 reached 250 mmHg or a maximal plateau pressure/PEEP of 60/45 cmH2O was achieved. The RM was performed with stepwise increases of 5 cmH2O of PEEP every 2 min and thereafter with stepwise decreases of 2 cmH2O of PEEP every 2 min until a drop in PaO2 >10% below the recruitment PEEP level. Data was collected before (preRM), during and after 30 min (posRM). Results:  The PaO2/FIO2 increased from 83 ± 22 mmHg preRM to 118 ± 32 mmHg posRM (P = 0.001). The Cs increased from 28 ± 10 ml cmH2O−1 preRM to 35 ± 12 ml cmH2O−1 posRM (P = 0.025). The PEEP was 12 ± 3 cmH2O preRM and was set at 15 ± 4 cmH2O posRM (P = 0.025). The PEEP of recruitment was 36 ± 9 cmH2O and the collapsing PEEP was 13 ± 4 cmH2O. The PaO2 of recruitment was 225 ± 105 mmHg, with five patients reaching a PaO2  ≥ 250 mmHg. The FIO2 decreased from 0.76 ± 0.16 preRM to 0.63 ± 0.15 posRM (P = 0.001). No major complications were detected. Conclusions:  Recruitment maneuver was safe and useful to improve oxygenation and Cs in patients with severe ARDS ventilated with lung-protective strategy.