Abstract
Background:
Atelectasis and hypoxemia may occur in invasively ventilated patients undergoing bronchoscopy. This study aimed to assess the respiratory effects of recruitment maneuver (RM) in these patients and explore the population likely to benefit from RM after bronchoscopy.
Methods:
This single-center, prospective, observational study included subjects undergoing bronchoscopy who were invasively ventilated. RM was performed 5 min after bronchoscopy by maintaining breaths at a pressure control of 20 cm H2O and a PEEP of 20 cm H2O for 1 min. Lung aeration, monitored using electrical impedance tomography (EIT), was assessed throughout the study. High recruitability was defined as an increase in end-expiratory lung impedance (EELI) greater than 20% relative to its value before RM (△EELI/EELI), along with a decrease in the global inhomogeneity (GI) index due to RM.
Results:
Of the 80 subjects who completed the study, 32 met the predefined criteria for high recruitability. Subjects’ respiratory-system compliance (CRS) before bronchoscopy (odds ratio [OR] 0.921 [0.854–0.993], P = .032) and the decrease in the ratio of PaO2/FIO2 due to bronchoscopy (OR 0.097 [0.020–0.457], P = .003) were significantly associated with high recruitability. In subjects with high recruitability, significant improvements were observed in CRS in the dorsal region (15.3 ± 6.3 vs 13.5 ± 6.0, P = .002), center of ventilation (43.8 ± 4.8 vs 43.0 ± 4.8, P = .01), GI index (0.39 ± 0.07 vs 0.44 ± 0.08, P < .001), and PaO 2 /FIO 2 (257.1 ± 123.5 vs 212 ± 106.6, P < .001) due to RM after fiberoptic bronchoscopy, while no such benefits were observed in subjects exhibiting low recruitability.
Conclusions:
In subjects with lower CRS before bronchoscopy and a decreased PaO2/FIO2 due to bronchoscopy, RM after bronchoscopy improved CRS in the dorsal regions, promoted more uniform ventilation, and improved oxygenation. These patients are likely to benefit more from post-bronchoscopy RM.
Keywords
Get full access to this article
View all access options for this article.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
