Re-inflation Technique Aids ARDS Patients

Danish researchers have found that a re-inflating the lungs twice after endotracheal suctioning (ETS) can be effective in rapidly regaining lung volume and improving oxygenation in patients with acute respiratory syndrome (ARDS). Their study was published in the October 31, 2002, issue of Critical Care.

The researchers performed one of two suctioning procedures on eight patients who were mechanically ventilated with acute lung injury or ARDS. In the first procedure, ETS was followed by a re-inflation or lung recruitment (LR) maneuver and reconnection to the ventilator with positive end-expiratory pressure (PEEP) set at 1 cm H2O above the lower inflexion point. After 60 minutes, another ETS without the LR maneuver was performed followed by reconnection to the ventilator with similar PEEP. The second procedure was the same as the first but conducted in reverse order. The results showed that with the LR maneuver, end-expiratory lung volume was unchanged after ETS but without the LR maneuver, end-expiratory volume was still reduced.

Following discontinuation of PEEP, lung collapse can occur rapidly in ventilator-treated patients with ARDS, the researchers note. Suctioning abolishes the positive airway pressure and may even generate negative pressure, promoting de-recruitment and hypoxemia. The LR maneuver is not meant as a preventive measure but rather as a therapeutic measure to regain lung volume and oxygenation rapidly after ETS. The study was conducted by Dr. Thomas Dyhr and colleagues from the department of anesthesiology at Gentofte University Hospital (Hellerup, Denmark).