Noninvasive Positive Pressure Ventilated Recruitment Maneuvers In The Early Stage Of Acute Respiratory Distress Syndrome

Objective:To evaluate the clinical efficacy of noninvasive positive pressure ventilated recruitment maneuvers in the treatment of patients at the early stage of acute respiratory distress syndrome.Methods:Nineteen acute respiratory distress syndrome (ARDS) patients caused by multiple expulmonary diseases within 72 hours from the beginning hospitalized in intensive care unit(ICU) were enrolled in this study from May 2006 to February 2007. When these patients were treated in ICU with one hour based noninvasive positive pressure ventilation, the recruitment maneuvers(RM) were used by maintaining inspiratory positive airway pressure(IPAP)20cmH20 and expiratory positive airway pressure (EPAP) 20 cmH20 for 120 seconds. Blood gas parameters such as potential of hydrogen (PH), partial pressure of carbon dioxide in arterial blood(PCO2), partial pressure of oxygen in arterial blood(PO2)and partial pressure of oxygen in arterial blood/fraction of inspired oxygen(PO2/FiO2) were observed before and after the RM 30 minutes, 1 hour and 3 hours. Hemodynamics parameters such as heart rates(HR), mean arterial pressure(MAP) and blood pressure(BP) also were observed before and after the RM 30 minutes, 1 hour and 3 hours.Results:two patients were out of this experiment because of the high gas flow of the RM, the others were well tolerated. PO2 increased from 72.12±11.51 mmHg to 107.47±15.77mmHg 30 minutes after the RM and PO2/FiO2 increased from 159.00±24.56 mmHg to 238.34±40.41 mmHg compared with before the RM. There had significant difference(P<0.001).One hour after the RM compared with before it, there had difference also (P<0.01). Three hours after the RM, PO2 and PO2/FiO2 decrease to the values of before it. HR, MAP ,BP, PH and PCO2 had no significant changes before and after the RM(P>0.05).Conclusions :For patients with ARDS in the early stage received NPPV , RM of using IPAP 20 cmH20 and EPAP 20 cmH20 for 120 seconds was effective and safe. It could provide effective improving of lung oxygenation, and have no side effects.