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. 2019 Feb 10;8(2):231.
doi: 10.3390/jcm8020231.

Effects of Stepwise Lung Recruitment Maneuvers in Patients with Early Acute Respiratory Distress Syndrome: A Prospective, Randomized, Controlled Trial

Shu-Chen Kung  1 , Yi-Li Hung  2   3 , Wan-Ling Chen  4 , Ching-Min Wang  5 , Hui-Chun Chang  6 , Wei-Lun Liu  7   8
Affiliations

Effects of Stepwise Lung Recruitment Maneuvers in Patients with Early Acute Respiratory Distress Syndrome: A Prospective, Randomized, Controlled Trial

Shu-Chen Kung et al. J Clin Med. .

Abstract

Since the clinical benefit of lung recruitment maneuvers (LRMs) is still conflicting, we performed this prospective, randomized, controlled study to investigate whether LRMs should be used in the routine management of acute respiratory distress syndrome (ARDS). This trial was conducted in four intensive care units (ICUs) to compare application of a modified stepwise LRMs with solely lung-protective ventilation in patients with moderate to severe ARDS within 72 h from the onset. The primary outcome was 28-day mortality, and the secondary outcomes were ventilator-free days and ICU-free days. We collected data on 120 ARDS patients from 2009 to 2012, and there was no difference in 28-day mortality between the two groups (28.3% vs. 30.0%, p = 0.84). However, among survivors, patients in the LRM group had a significant longer median duration of ventilator-free days (18 vs. 13 days; p = 0.04) and ICU-free days (16 vs. 11 days; p = 0.03) at 28 days than in the control group. The respiratory system compliance was significantly higher in the LRM group from day 1 to day 7. The occurrence rate of barotrauma was similar in both groups. We concluded that LRMs combined with lung-protective ventilation in early ARDS may improve patient outcomes.

Keywords: Trial registration: ClinicalTrials.gov, Identifier: NCT01114009..

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Diagram of a stepwise lung recruitment maneuver followed by decremental positive end-expiratory pressure titration applied in the study. (T MAX, maximum time).
Figure 2
Figure 2
Flow chart of the study. ARDS, acute respiratory distress syndrome, LRM, lung recruitment maneuver.
Figure 3
Figure 3
Probability of survival from day of randomization to day 60 among patients in the lung recruitment maneuver (LRM) group and control group.
See this image and copyright information in PMC

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