Abstract：
BACKGROUND:Percutaneous dilational tracheostomy (PDT) can potentially lead to hypoxia and alveolar derecruitment. The aim of this prospective study was to evaluate the efficacy of performing a recruitment maneuver (RM) before tracheostomy, in order to improve oxygenation. METHODS:We enrolled 29 eligible trauma patients with acute lung injury criteria requiring tracheostomy in a university ICU. Subjects were ventilated on volume controlled mechanical ventilation (tidal volume of 6 mL/kg) and F(IO(2)) set at 1.0. Subjects were randomized into 2 groups: RM group (subjects who underwent RM 10 min before PDT, 15 subjects) and no-RM group (subjects without application of RM before PDT, 14 subjects). RM was performed by imposition of continuous positive airway pressure of 40 cm H(2)O for 40 seconds. We collected gas exchange, respiratory, and hemodynamic data 5 times: 1 hour before RM, 5 min after RM, 5 min after PDT, 30 min after PDT, and 6 hours after PDT. RESULTS:Subjects who underwent RM had a significant increase in P(aO(2)); 5 min after the maneuver, P(aO(2)) increased from 222.6 ± 33.4 mm Hg to 341.3 ± 33.1 mm Hg (P < .01) and was always significantly maintained throughout the following times of the study, compared to the no-RM group: in the RM and no-RM groups, respectively, 260.7 ± 35.4 mm Hg vs 108.5 ± 36.9 mm Hg 5 min after PDT; 285.6 ± 29.1 mm Hg vs 188.4 ± 21.4 mm Hg 30 min after PDT; and 226.3 ± 24.8 mm Hg vs 147.6 ± 42.8 mm Hg 6 h after PDT (P < .01). CONCLUSIONS:Our study suggests that application of RM before PDT could be useful to avoid hypoxemia following such procedure, by reducing fall in P(aO(2)) and preventing the decrease in oxygenation values below baseline at 6 hours.
journal_name
Respir Carejournal_title
Respiratory careauthors
Franchi F,Cubattoli L,Faltoni A,Scolletta S,Falciani E,Mastrocinque E,Giomarelli P,Patroniti Ndoi
10.4187/respcare.01798subject
Has Abstractpub_date
2012-11-01 00:00:00pages
1850-6issue
11eissn
0020-1324issn
1943-3654pii
rc01798r1franchijournal_volume
57pub_type
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