The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

LUNG RECRUITMENT MANEUVERS TO TREAT ATELECTASIS IN VENTILATED SURGICAL PATIENTS

J. A. Bosanac1, T. D. Emrick1, J. M. Hensley1, K. Bauser1, C. Haas1, D. Napolitano1


Background: Sustained inflation with moderate pressure is used in the OR to reverse intra-operative atelectasis and the ICU with ventilated patients having difficulty oxygenating. We apply recruitment maneuvers (RM) to mechanically ventilated (MV) patients with atelectasis per chest radiography (CXR) but adequate oxygenation. The study objective was to determine whether our current RM practice was effective in treating atelectasis.

Methods: We conducted a retrospective quality improvement review of RM’s. Included patients received MV and RMs ordered for atelectasis. Patients with FIO2 >0.50 were excluded. Standard practice was to apply 40 cmH2O pressure for 40 s every 4 hr (per MD order), and modified to patient response. Data collected included: diagnosis, age, sex; MV reason, ventilator settings; baseline and post-RM PIP, VT, PEEP, MAP, HR, BP, and ABG for the initial and last RM; pressure and duration during RM, and daily radiologist’s CXR interpretation.

Results: Fifteen patients (60% male) were studied; 73% had an abdominal procedure. Baseline values (mean +SD (range)) were: PEEP=8.7+2.3 cm H2O (5-12), SpO2=96.3+2.6% (93-100), FIO2=0.347+.074 (0.3-0.5), PaO2/FIO2=241+79 (154-402). There was no significant difference in any pre vs post hemodynamic or gas exchange measure on either the initial or final RM. SpO2 increased from pre-initial period to 1-hr post RM (93.9 vs 96.5%, p=0.034). Each patient received a mean of 73+84 (4-320) RMs over a 12.6+14.5 day (1-58) period. Two initial RMs were stopped early for hypotension, but resumed with modified settings. One final RM was stopped early for bradycardia (103 to 50) on day 18. The table shows CXR changes prior to initial and final RM; there was no apparent reduction in atelectasis.

Conclusion: RM’s are safe and well tolerated in most patients, but did not cause gross improvement in atelectasis. Study limitations include not using a single CXR interpreter and possibly not using adequate RM and PEEP settings.Chest X-ray findings (%)


 Atelectasis Effusion Infiltrate Air Leak
Pre-Initial RM 86.7 66.7 6.7 0.0
Pre-Final RM 93.3 60.0 0.0 0.0
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