Safety and efficacy of a stepwise recruitment maneuver in patients with acute respiratory distress syndrome/acute lung injury

Author(s)

Valdelis Novis Okamoto

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2003-10-30

Examining board members

Marcelo Britto Passos Amato; Carlos Roberto Ribeiro de Carvalho; Sergio Eduardo Demarzo; Patricia Rieken Macedo Rocco; Renato Giuseppe Giovanni Terzi

• Advisor: Marcelo Britto Passos Amato

Abstract

A stepwise recruiting maneuver targeting minimal lung collapse was developed in a tomographic study in patients with acute respiratory distress syndrome/ acute lung injury (ARDS / ALI). PaO2 + PaCO2 >= 400 mmHg assessed by intrarterial blood gases was consistent with full recruitment on tomographic sections. To assess the safety and efficacy of a stepwise recruitment maneuver in terms of its effect on gas exchange and hemodynamic variables of clinical relevance, twelve ARDS/ALI patients, extensively monitored, were submitted to the maneuver until full recruitment, adverse effects or plateau pressure = 60cmH2O. All patients achieved PaO2 + PaCO2 >= 400 mmHg with the recruitment protocol, which was well tolerated, did not cause barotrauma and resulted in the maintenance of high PaO2/ FIO2 within 6 h (AU)