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Acute Hemodynamic Effects of Recruitment Maneuvers in Patients With Acute Respiratory Distress Syndrome

Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea, parkkj{at}ajou.ac.kr

Yoon Jung Oh, MD

Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea

Hyuk Jae Chang, MD, PhD

Department of Cardiology, Ajou University School of Medicine, Suwon, South Korea

Seung Soo Sheen, MD

Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea

Junghyun Choi, MD

Department of Cardiology, Ajou University School of Medicine, Suwon, South Korea

Keu Sung Lee, MD

Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea

Joo Hun Park, MD

Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea

Sung Chul Hwang, MD

Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea

Background: The recruitment maneuver (RM) in acute respiratory distress syndrome (ARDS) can cause hemodynamic derangement. We evaluated circulatory and cardiac changes during RMs.

Methods: We performed sustained inflation (SI) with a pressure of 40 cm H₂O for 30 seconds as an RM on 22 patients with ARDS. Blood pressure (BP) and heart rate were recorded immediately before, every 10 seconds during, and 30 seconds after the RM. Ventricular dimensions were obtained simultaneously using M-mode echocardiography, and tissue Doppler imaging was performed on the left ventricular wall.

Results: Mean, systolic, and diastolic BP decreased at 20 and 30 seconds during 30-second RMs (mean BP: 92 ± 12 at baseline to 83 ± 18 mm Hg at the end of the RM, P < .05) and subsequently recovered. Heart rate decreased at 10 and 20 seconds during the RM, and tended to increase afterward. Both ventricular dimensions decreased significantly during the RM. The left ventricular ejection fraction and peak velocity of the left ventricle during systole remained stable. The fractional changes in mean BP and left ventricular end-diastolic dimension during the RMs were correlated significantly with each other (r_s = 0.59). Static compliance of the respiratory system (Crs) was lower in patients with mean BP change 15% than in patients in whom the change was <15% (P < .05).

Conclusions: A transient decrease in mean BP was observed during the RM, and its degree was correlated with the preload decrease, while cardiac contractility was maintained.

Key Words: recruitment maneuver • acute respiratory distress syndrome • hemodynamics • echocardiography • compliance

This version was published on November 1, 2009

Journal of Intensive Care Medicine, Vol. 24, No. 6, 376-382 (2009)
DOI: 10.1177/0885066609344952


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