肺复张手法可改善急性呼吸窘迫综合征患者的右心室和左心室功能。

Lung recruitment maneuver improves right and left ventricular function in patients with acute respiratory distress syndrome.

作者信息

Lambour Alexis, Zerbib Yoann, Mercado Pablo, Kontar Loay, Cagny Bertrand De, Maizel Julien, Slama Michel, Brault Clément

机构信息

Medical Intensive Care Department, Amiens-Picardie University Hospital, 1 rue du Professeur Christian Cabrol, Amiens, 80000, France.

MP3CV Laboratory, UR 7517, Jules Verne University of Picardie, Amiens, France.

出版信息

BMC Pulm Med. 2025 May 31;25(1):274. doi: 10.1186/s12890-025-03735-5.

DOI:10.1186/s12890-025-03735-5

PMID:40450243

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12125777/

Abstract

BACKGROUND

Lung recruitment maneuvers (LRM) and high positive end-expiratory pressure (PEEP) may benefit some patients by reopening non- or poorly aerated alveoli. However, the effects of opening the lung with LRM on hemodynamics remain uncertain. This study aimed to evaluate the direct impact of LRM on cardiac function in patients with moderate-to-severe acute respiratory distress syndrome (ARDS).

METHODS

This post-hoc analysis included 34 patients with moderate-to-severe ARDS from two prospective cohort studies. The LRM consisted in a gradual increase in PEEP, starting from 25 cmHO (PEEP, before the recruitment maneuver at PEEP 25 cmHO) until reaching 40 cmHO. After LRM, PEEP was decreased to 25 cmHO (PEEP, after the recruitment maneuver, also at PEEP 25 cmHO) followed by a decremental PEEP titration. We compared the size and function of the right ventricle (RV) and left ventricle (LV) between PEEP and PEEP.

RESULTS

The respiratory system compliance significantly increased from 21 ± 7 ml/cmHO at PEEP to 24 ± 7 ml/cmHO at PEEP ( < 0.001), indicating effective lung recruitment. The RV end-diastolic diameter and the RV/LV ratio decreased after LRM (51 ± 11 vs. 41 ± 9 mm; < 0.001, and 1.05 ± 0.21 vs. 0.90 ± 0.18; < 0.001, respectively), suggesting reduced pulmonary vascular resistance. The RV free wall strain improved from -22 ± 10 to -25 ± 8% ( = 0.040). The cardiac index significantly increased from 2.1 ± 0.6 to 2.4 ± 0.7 L/min/m2 ( < 0.001) due to improved LV function, as demonstrated by a lower LV global longitudinal strain at PEEP (-16 ± 4% vs. -19 ± 3%, = 0.002).

CONCLUSIONS

LRM may benefit both the lungs and the heart. The increase in transpulmonary pressure leads to an expansion in aerated lung volume, potentially reducing lung overdistension and collapse, thereby lowering RV afterload and improving RV systolic function.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12890-025-03735-5.

摘要

背景

肺复张手法（LRM）和高呼气末正压（PEEP）可能通过重新开放未通气或通气不良的肺泡使部分患者受益。然而，LRM肺开放对血流动力学的影响仍不确定。本研究旨在评估LRM对中重度急性呼吸窘迫综合征（ARDS）患者心功能的直接影响。

方法

这项事后分析纳入了来自两项前瞻性队列研究的34例中重度ARDS患者。LRM包括从25 cmH₂O（PEEP₂₅，复张手法前的PEEP为25 cmH₂O）开始逐渐增加PEEP直至达到40 cmH₂O。LRM后，PEEP降至25 cmH₂O（PEEP₂₅，复张手法后的PEEP也为25 cmH₂O），随后进行递减PEEP滴定。我们比较了PEEP₂₅和PEEP₄₀时右心室（RV）和左心室（LV）的大小及功能。

结果

呼吸系统顺应性从PEEP₂₅时的21±7 ml/cmH₂O显著增加至PEEP₄₀时的24±7 ml/cmH₂O（P＜0.001），表明肺复张有效。LRM后RV舒张末期直径和RV/LV比值降低（分别为51±11 vs. 41±9 mm；P＜0.001，以及1.05±0.21 vs. 0.90±0.18；P＜0.001），提示肺血管阻力降低。RV游离壁应变从-22±10%改善至-25±8%（P = 0.040）。由于LV功能改善，心脏指数从2.1±0.6显著增加至2.4±0.7 L/min/m²（P＜0.001），PEEP₄₀时LV整体纵向应变较低证明了这一点（-16±4% vs. -19±3%，P = 0.002）。