Influence of Low Tidal Volumes on Gas Exchange in Acute Respiratory Distress Syndrome and the Role of Recruitment Maneuvers

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Abstract
Use of a low tidal volume (VT) strategy in the treatment of acute respiratory distress syndrome can lead to a decrease in oxygenation. This study evaluated the safety and efficacy of a recruitment maneuver (RM) in this setting. Twelve patients with acute respiratory distress syndrome were studied within 48 hours of diagnosis. Baseline gas exchange, hemodynamics, and respiratory mechanics were determined and patients were placed on a VT of 6 mL/kg. Measurements were repeated and an RM of 30 cm H20 for 40 seconds was performed. Measurements were repeated at 30 minutes and 2 hours post-RM. Decreasing VT resulted in a decrease in arterial oxygenation (from 91 ± 9 mm Hg to 75 ± 9 mm Hg, p Conclusion An RM transiently improves gas exchange during low VT ventilation. RMs are well tolerated and no hemodynamic consequences were seen.