RT Journal Article
SR Electronic
T1 Complications From Recruitment Maneuvers in Patients With Acute Lung Injury: Secondary Analysis From the Lung Open Ventilation Study
JF Respiratory Care
FD American Association for Respiratory Care
SP 1842
OP 1849
DO 10.4187/respcare.01684
VO 57
IS 11
A1 Fan, Eddy
A1 Checkley, William
A1 Stewart, Thomas E
A1 Muscedere, John
A1 Lesur, Olivier
A1 Granton, John T
A1 Freitag, Andreas P
A1 Jacka, Michael
A1 Ferguson, Niall D
A1 Meade, Maureen O
YR 2012
UL http://rc.rcjournal.com/content/57/11/1842.abstract
AB BACKGROUND: There are limited data on the safety and efficacy of recruitment maneuvers (RMs) in acute lung injury (ALI) patients. OBJECTIVE: To evaluate the frequency, timing, and risk factors for complications from RMs in adult ALI patients. METHODS: Secondary analysis of data from a randomized controlled trial of a lung open ventilation strategy that included sustained inflation RMs. RESULTS: Respiratory (eg, desaturation) and cardiovascular (eg, hypotension) complications from recruitment maneuvers were common (22% of all patients receiving RMs), and the majority occurred within 7 days of enrollment. New air leak through an existing chest tube was uncommon (< 5%). As compared to patients receiving 1 or fewer RMs, the number of RMs received was associated with increased risk in both younger (age ≤ 56 y) and older patients (age > 56 y): 2 RMs odds ratio [OR] 6.92 (95% CI 1.70–28.2), ≥ 3 RMs OR 15.4 (95% CI 4.77–49.6), and 2 RMs OR 5.43 (95% CI 1.76–16.8), ≥ 3 RMs OR 4.93 (95% CI 1.78–13.7), respectively. Patients with extrapulmonary ALI had decreased odds of developing complications (OR 0.42, 95% CI 0.22–0.80). CONCLUSIONS: Complications in adult ALI patients receiving RMs were common, but serious complications (eg, new air leak through an existing chest tube) were infrequent. There is a significant association between the number of RMs received and complications, even after controlling for illness severity and duration. Given their uncertain benefit in ALI patients, and the potential for complications with repeated application, the routine use of sustained inflation RMs is not justified.