Smetkin Alexey A, Kuzkov Vsevolod V, Gaidukov Konstantin M, Bjertnaes Lars J, Kirov Mikhail Y
Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Avenue 51, Arkhangelsk 163000, Russia.
Crit Care Res Pract. 2012;2012:428798. doi: 10.1155/2012/428798. Epub 2012 Aug 15.
Introduction. A recruitment maneuver (RM) may improve gas exchange in acute lung injury (ALI). The aim of our study was to assess the predictive value of a derecruitment test in relation to RM and to evaluate the efficacy of RM combined with surfactant instillation in patients with ALI. Materials and Methods. Thirteen adult mechanically ventilated patients with ALI were enrolled into a prospective pilot study. The patients received protective ventilation and underwent RM followed by a derecruitment test. After a repeat RM, bovine surfactant (surfactant group, n = 6) or vehicle only (conventional therapy group, n = 7) was instilled endobronchially. We registered respiratory and hemodynamic parameters, including extravascular lung water index (EVLWI). Results. The derecruitment test decreased the oxygenation in 62% of the patients. We found no significant correlation between the responses to the RM and to the derecruitment tests. The baseline EVLWI correlated with changes in SpO(2) following the derecruitment test. The surfactant did not affect gas exchange and lung mechanics but increased EVLWI at 24 and 32 hrs. Conclusions. Our study demonstrated no predictive value of the derecruitment test regarding the effects of RM. Surfactant instillation was not superior to conventional therapy and might even promote pulmonary edema in ALI.
引言。复张手法（RM）可能会改善急性肺损伤（ALI）患者的气体交换。我们研究的目的是评估肺不张试验对RM效果的预测价值，并评估RM联合肺表面活性物质注入对ALI患者的疗效。材料与方法。13例成年ALI机械通气患者纳入一项前瞻性初步研究。患者接受保护性通气并进行RM，随后进行肺不张试验。重复RM后，经支气管注入牛肺表面活性物质（肺表面活性物质组，n = 6）或仅注入赋形剂（传统治疗组，n = 7）。我们记录了呼吸和血流动力学参数，包括血管外肺水指数（EVLWI）。结果。肺不张试验使62%的患者氧合降低。我们发现RM反应与肺不张试验反应之间无显著相关性。基线EVLWI与肺不张试验后SpO₂的变化相关。肺表面活性物质对气体交换和肺力学无影响，但在24小时和32小时时增加了EVLWI。结论。我们的研究表明肺不张试验对RM效果无预测价值。肺表面活性物质注入并不优于传统治疗，甚至可能会促进ALI患者发生肺水肿。
