Fan Eddy, Wilcox M Elizabeth, Brower Roy G, Stewart Thomas E, Mehta Sangeeta, Lapinsky Stephen E, Meade Maureen O, Ferguson Niall D
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Am J Respir Crit Care Med. 2008 Dec 1;178(11):1156-63. doi: 10.1164/rccm.200802-335OC. Epub 2008 Sep 5.
There are conflicting data regarding the safety and efficacy of recruitment maneuvers (RMs) in patients with acute lung injury (ALI).
To summarize the physiologic effects and adverse events in adult patients with ALI receiving RMs.
Systematic review of case series, observational studies, and randomized clinical trials with pooling of study-level data.
Forty studies (1,185 patients) met inclusion criteria. Oxygenation (31 studies; 636 patients) was significantly increased after an RM (PaO2): 106 versus 193 mm Hg, P = 0.001; and PaO2/FiO2 ratio: 139 versus 251 mm Hg, P < 0.001). There were no persistent, clinically significant changes in hemodynamic parameters after an RM. Ventilatory parameters (32 studies; 548 patients) were not significantly altered by an RM, except for higher PEEP post-RM (11 versus 16 cm H2O; P = 0.02). Hypotension (12%) and desaturation (9%) were the most common adverse events (31 studies; 985 patients). Serious adverse events (e.g., barotrauma [1%] and arrhythmias [1%]) were infrequent. Only 10 (1%) patients had their RMs terminated prematurely due to adverse events.
Adult patients with ALI receiving RMs experienced a significant increase in oxygenation, with few serious adverse events. Transient hypotension and desaturation during RMs is common but is self-limited without serious short-term sequelae. Given the uncertain benefit of transient oxygenation improvements in patients with ALI and the lack of information on their influence on clinical outcomes, the routine use of RMs cannot be recommended or discouraged at this time. RMs should be considered for use on an individualized basis in patients with ALI who have life-threatening hypoxemia.
关于急性肺损伤（ALI）患者中肺复张手法（RMs）的安全性和有效性，存在相互矛盾的数据。
总结接受RMs的成年ALI患者的生理效应和不良事件。
对病例系列、观察性研究和随机临床试验进行系统综述，并汇总研究水平的数据。
40项研究（1185例患者）符合纳入标准。肺复张手法后氧合（31项研究；636例患者）显著改善（动脉血氧分压[PaO2]）：106对193mmHg，P = 0.001；动脉血氧分压/吸入氧分数值（PaO2/FiO2）比值：139对251mmHg，P < 0.001）。肺复张手法后血流动力学参数无持续的、具有临床意义的变化。通气参数（32项研究；548例患者）在肺复张手法后无显著改变，但肺复张手法后呼气末正压（PEEP）较高（11对16cmH2O；P = 0.02）。低血压（12%）和血氧饱和度下降（9%）是最常见的不良事件（31项研究；985例患者）。严重不良事件（如气压伤[1%]和心律失常[1%]）较少见。仅10例（1%）患者因不良事件而提前终止肺复张手法。
接受肺复张手法的成年ALI患者氧合显著增加，严重不良事件较少。肺复张手法期间短暂的低血压和血氧饱和度下降很常见，但为自限性，无严重短期后遗症。鉴于ALI患者短暂改善氧合的益处不确定，且缺乏其对临床结局影响的信息，目前不能推荐或不鼓励常规使用肺复张手法。对于有危及生命的低氧血症的ALI患者，应考虑个体化使用肺复张手法。
