Critical Care

official impact factor 4.60
Search for
Advanced search
Critical Care
Tools
Share this article
Open Access Highly Access Research

A recruitment maneuver increases oxygenation after intubation of hypoxemic intensive care unit patients: a randomized controlled study

Jean-Michel Constantin1*, Emmanuel Futier1, Anne-Laure Cherprenet1, Gérald Chanques2, Renaud Guerin1, Sophie Cayot-Constantin1, Mathieu Jabaudon1, Sebastien Perbet1, Christian Chartier1, Boris Jung2, Dominique Guelon3, Samir Jaber2 and Jean-Etienne Bazin1

Author Affiliations

1 General ICU, Department of Anesthesiology and Critical-Care, Estaing Hospital, University Hospital of Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France

2 Surgical ICU and Department of Anesthesiology, DAR B University Hospital of Montpellier, and Saint-Eloi Hospital, Montpellier University, 80 Avenue Augustin Fliche34000 Montpellier, France

3 Medico-Surgical ICU, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, 58 Bd Montalambert, 63000 Clermont-Ferrand, France

For all author emails, please log on.

Critical Care 2010, 14:R76 doi:10.1186/cc8989


See related commentary by Valenza, http://ccforum.com/content/14/4/173

Published: 28 April 2010

Abstract

Introduction

Tracheal intubation and anaesthesia promotes lung collapse and hypoxemia. In acute lung injury patients, recruitment maneuvers (RMs) increase lung volume and oxygenation, and decrease atelectasis. The aim of this study was to evaluate the efficacy and safety of RMs performed immediately after intubation.

Methods

This randomized controlled study was conducted in two 16-bed medical-surgical intensive care units within the same university hospital. Consecutive patients requiring intubation for acute hypoxemic respiratory failure were included. Patients were randomized to undergo a RM immediately (within 2 minutes) after intubation, consisting of a continuous positive airway pressure (CPAP) of 40 cmH2O over 30 seconds (RM group), or not (control group). Blood gases were sampled and blood samples taken for culture before, within 2 minutes, 5 minutes, and 30 minutes after intubation. Haemodynamic and respiratory parameters were continuously recorded throughout the study. Positive end expiratory pressure (PEEP) was set at 5 cmH2O throughout.

Results

The control (n = 20) and RM (n = 20) groups were similar in terms of age, disease severity, diagnosis at time of admission, and PaO2 obtained under 10-15 L/min oxygen flow immediately before (81 ± 15 vs 83 ± 35 mmHg, P = 0.9), and within 2 minutes after, intubation under 100% FiO2 (81 ± 15 vs 83 ± 35 mmHg, P = 0.9). Five minutes after intubation, PaO2 obtained under 100% FiO2 was significantly higher in the RM group compared with the control group (93 ± 36 vs 236 ± 117 mmHg, P = 0.008). The difference remained significant at 30 minutes with 110 ± 39 and 180 ± 79 mmHg, respectively, for the control and RM groups. No significant difference in haemodynamic conditions was observed between groups at any time. Following tracheal intubation, 15 patients had positive blood cultures, showing microorganisms shared with tracheal aspirates, with no significant difference in the incidence of culture positivity between groups.

Conclusions

Recruitment maneuver following intubation in hypoxemic patients improved short-term oxygenation, and was not associated with increased adverse effects.

Trial registration

NCT01014299