Recruitment manoeuvres, consisting of sustained inflations at high airway pressures, have been advocated as an adjunct to mechanical ventilation in lung protective ventilation strategies to prevent the collapse of the lung. This study aims to determine the safety and efficacy of a recruitment manoeuvre, by considering its impact on gas exchange, hemodynamics and on the release of systemic inflammatory mediators.
This prospective study will analyse the effects of a single recruitment manoeuvre in critically ill patients. Subjects will be mechanically ventilated patients needing alveolar RMs. After a period of stable lung protective approach ventilation, they will receive the "40/30" RM; lung mechanics, gas exchange, hemodynamics and plasmatic concentration of inflammatory mediators will be obtained before and after the RM. An ultrasound score, established from the lung aeration status of upper and lower parts of anterior and lateral chest wall, will also be calculated before and after the manoeuvre.In selected patients cytokine release in the bronchoalveolar lavage will be measured as well.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
10
The ventilator will be switched to the continuous positive airway pressure (CPAP) mode and the pressure will be increased to 40 cmH20 for 30 seconds.
continuous positive airway pressure (CPAP)
U.O. Anestesia e Rianimazione IV, Azienda Ospedaliero Universitaria Pisana
Pisa, Pisa, Italy
RECRUITINGPlasmatic concentration of inflammatory mediators IL-1, IL-6, IL-8, IL-10, TNFa
Time frame: T0 (baseline), T4 (3 hrs), T5 (12 hrs)
Plasmatic concentration of Nitric Oxide
Time frame: T0 (baseline), T6 (24 hrs)
Lung mechanics (Peak pressure, Mean pressure, Compliance, Resistance) Gas exchange (pH, PaO2, PaCO2, HCO3-, SaO2, PaO2/FiO2) Haemodynamics (Mean arterial pressure, Heart rate)
Time frame: T0 (baseline), T1 (30 secs), T2 (1 hr), T3 (2 hrs)
Echographic score of lung aeration
Time frame: T0 (baseline), T2 (1 hr), T4 (3 hrs)
Chest X-Ray
Time frame: T6 (24 hrs)
Levels of IL-1, IL6, IL-8, IL-19, TNFa in the bronchoalveolar lavage
Time frame: T0 (baseline), T4 (3 hrs)
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