Safety and efficacy of a sustained inflation for alveolar recruitment in adults with respiratory failure

Objective: To assess the safety and efficacy of a sustained inflation, used as a lung volume recruitment maneuver in ventilated patients with hypoxemic respiratory failure. Design: Prospective data collection as part of a quality assurance program following introduction of a lung volume recruitment guideline in the intensive care unit. Setting: Academic medical-surgical critical care unit. Patients: Hypoxemic patients with bilateral pulmonary infiltrates. Patients with chronic obstructive pulmonary disease, pulmonary barotrauma and hemodynamic instability were excluded. Interventions. A sustained inflation using a pressure of 30 to 35 cmH(2)O was applied for 20 s. The pressure was determined as the lesser of 45 cmH(2)O or the peak pressure while ventilated at a tidal volume of 12 ml/kg. Intra-arterial blood pressure and pulse oximetry were monitored continuously. Measurements and results: Significant improvement in oxygenation occurred in the majority of patients within 10 min. The mean oxygen saturation improved from 86.9 +/- 5.5 to 94.3 +/- 2.3% (p < 0.01). No significant adverse effects were noted: hypotension and mild oxygen desaturation occurred in some patients during the 20-s inflation, reversing rapidly after inflation was terminated. No barotrauma occurred. Conclusions: A sustained inflation is a safe, clinically applicable method of lung volume recruitment which Improves oxygenation in selected patients and may have a role in ventilatory management.