Aydin Pelin, Kizilkaya Mehmet
Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
Department of Anaesthesiology and Reanimation, Amasya University School of Medicine, Amasya, Turkey.
Eurasian J Med. 2022 Oct;54(3):274-280. doi: 10.5152/eurasianjmed.2022.21120.
The most efficient recruitment maneuver (RM) for oxygenation in patients under mechanical circulatory support with acute respiratory distress syndrome (ARDS) has not been described yet. In this study, we have evaluated the effects of three recruitment maneuvers on oxygenation and intracranial pressure.
20 sheep have been randomly grouped as follows: ARDS control, ARDS+TV(Tidal Volume), ARDS+CPAP(Continuous Positive Airway Pressure), ARDS+PEEP(Positive End Expiratory Pressure). Arterial blood gas tests have been done before ARDS, after ARDS, and 5,10, and 30 minutes after the maneuver. Intracranial pressures had been followed up.
There was a statistically significant increase in Pa02 (Partial arterial oxygen pressure) values in all groups 5 minutes after RM (P > 0,01). There was a statistically increase in Pa02 values in all groups 10 and 30 minutes after the RM (P > 0,01). TV group had significantly more increase in PaO2 increase at the 30th the other groups (P > 0,01). CPAP group had more increase in intracranial pressures just after the RM and at 5 and 10 minutes after the RM. This increase was statistically significant (P > 0,01). All groups had similar intracranial pressure values 30 minutes after the RM. There was no statiscally signifciant difference between the groups (P > 0,05).
ICP monitorisation should be carried out in patients with ARDS while performing recruitment maneuvers.
对于接受机械循环支持的急性呼吸窘迫综合征（ARDS）患者，尚未有关于最有效的氧合复张手法（RM）的描述。在本研究中，我们评估了三种复张手法对氧合和颅内压的影响。
20只绵羊被随机分组如下：ARDS对照组、ARDS+潮气量（TV）组、ARDS+持续气道正压通气（CPAP）组、ARDS+呼气末正压通气（PEEP）组。在ARDS发生前、ARDS发生后以及手法操作后5分钟、10分钟和30分钟进行动脉血气检测。对颅内压进行随访。
复张手法后5分钟，所有组的动脉血氧分压（Pa02）值均有统计学意义的升高（P>0.01）。复张手法后10分钟和30分钟，所有组的Pa02值均有统计学意义的升高（P>0.01）。在第30分钟时，TV组的PaO2升高显著高于其他组（P>0.01）。CPAP组在复张手法刚结束后以及手法后5分钟和10分钟时颅内压升高更多。这种升高具有统计学意义（P>0.01）。复张手法后30分钟，所有组的颅内压值相似。各组之间无统计学显著差异（P>0.05）。
对ARDS患者进行复张手法时应进行颅内压监测。
