Comparison For Intensive Versus Moderate Recruitment Maneuvers In The Treatment Of Patient With Severe Brain Injury

Objective:The aim of our study was to design a randomize controlled clinical trial that using Transcranial doppler ultrasonography to evaluate the intensive versus moderate recruitment maneuvers on middle cerebral artery hemodynamics in the patients with severe brain injury.Methods:Seventy patients with severe brain injury were randomized into two groups after admission to the intensive care unit:intensive recruitment maneuvers strategy and moderate recruitment maneuvers strategy.The ethical approval was granted by the Biological and Medical Ethics Committee of The First Affiliated Hospital of Xinjiang Medical University?20180622-02?.Trial registration number was ChiCTR1800019488.In the intensive strategy group,consisting of PEEP of 30cmH₂O for60 seconds,pressure-controlled ventilation under continuous positive airway pressure?PCV?mode,driving pressure of 15cmH₂O,respiratory rate of 15bmp/min,inspiratory time of 1.5 seconds,and FIO₂ of 0.40.In the moderate strategy group,under continuous positive airway pressure?CPAP?mode at 20cmH₂O and FIO₂ of 0.60 for 30 seconds.Application of transcranial doppler ultrasonography observation intensive versus moderate recruitment maneuvers in patients with severe brain injury in the cerebral blood flow velocity changes.Results:After recruitment maneuver,ICP was higher in intensive recruitment?20.50±4.75 vs 13.13±3.56 mm Hg;P=0.003?;and CPP was lower in intensive recruitment?62.38±9.81 vs 79.60±6.8 mm Hg;P=0.001?.5min after the recruitment maneuver,oxygenation index increased significantly only in moderate recruitment maneuvers?108.5 to 203.6;P=0.0078?.The peak systolic velocity,end-diastolic velocity and perfusion index related to cerebral hemodynamics in the moderate recruitment maneuvers group were significantly improved after 5 minutes of recruitment maneuvers compared with the intensive recruitment maneuvers group?P<0.05?.Conclusion:Pulmonary recruitment technique could result in increased oxygenation and decreased atelectasis in patients with severe brain injury,whereas intensive recruitment maneuvers provided more stable cerebral hemodynamic conditions than the moderate strategy.