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PEEP-Induced Lung Recruitment Maneuver Combined with Prone Position for ARDS: A Single-Center, Prospective, Randomized Clinical Trial.
Lan, Lan; Ni, Yuenan; Zhou, Yubei; Fu, Linxi; Wu, Wentao; Li, Ping; Yu, He; Liang, Guopeng; Luo, Fengming.
Afiliación
  • Lan L; Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China.
  • Ni Y; State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610064, China.
  • Zhou Y; Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China.
  • Fu L; State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610064, China.
  • Wu W; Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China.
  • Li P; State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610064, China.
  • Yu H; Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China.
  • Liang G; State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610064, China.
  • Luo F; Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China.
J Clin Med ; 13(3)2024 Feb 01.
Article en En | MEDLINE | ID: mdl-38337547
ABSTRACT

Background:

Prone position (PP) and the positive end-expiratory pressure (PEEP)-induced lung recruitment maneuver (LRM) are both efficient in improving oxygenation and prognosis in patients with ARDS. The synergistic effect of PP combined with PEEP-induced LRM in patients with ARDS remains unclear. We aim to explore the effects of PP combined with PEEP-induced LRM on prognosis in patients with moderate to severe ARDS and the predicting role of lung recruitablity.

Methods:

Patients with moderate to severe ARDS were consecutively enrolled. The patients were prospectively assigned to either the intervention (PP with PEEP-induced LRM) or control groups (PP). The clinical outcomes, respiratory mechanics, and electric impedance tomography (EIT) monitoring results for the two groups were compared. Lung recruitablity (recruitment-to-inflation ratio R/I) was measured during the PEEP-induced LRM procedure and was used for predicting the response to LRM.

Results:

Fifty-eight patients were included in the final analysis, among which 28 patients (48.2%) received PEEP-induced LRM combined with PP. PEEP-induced LRM enhanced the effect of PP by a significant improvement in oxygenation (∆PaO2/FiO2 75.8 mmHg vs. 4.75 mmHg, p < 0.001) and the compliance of respiratory system (∆Crs, 2 mL/cmH2O vs. -1 mL/cmH2O, p = 0.02) among ARDS patients. Based on the EIT measurement, PP combined with PEEP-induced LRM increased the ventilation distribution mainly in the dorsal region (5.0% vs. 2.0%, p = 0.015). The R/I ratio was measured in 28 subjects. The higher R/I ratio was related to greater oxygenation improvement after LRM (Pearson's r = 0.4; p = 0.034).

Conclusions:

In patients with moderate to severe ARDS, PEEP-induced LRM combined with PP can improve oxygenation and dorsal ventilation distribution. R/I can be useful to predict responses to LRM.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Clinical_trials / Prognostic_studies / Risk_factors_studies Idioma: En Revista: J Clin Med Año: 2024 Tipo del documento: Article País de afiliación: China Pais de publicación: Suiza
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Clinical_trials / Prognostic_studies / Risk_factors_studies Idioma: En Revista: J Clin Med Año: 2024 Tipo del documento: Article País de afiliación: China Pais de publicación: Suiza