Vliv otevíracího manévru na výměnu plynů, hemodynamiku a splanchnickou cirkulaci u ARDS pacientů

Impact of the opening manoeuvre on gas exchange, haemodynamics and the splanchnic circulation in ARDS patients

Objective:
To perform the recruitment manoeuvre (RM) in ARDS patients according to transalveolar pressure (Ptrans = airway pressure minus oesophageal pressure) and to evaluate its impact on gas exchange and the global and splanchnic haemodynamics.

Design:
Prospective, interventional study.

Setting:
Department of Anaesthesia & Intensive Care, St. Anna University Hospital, Brno, Czech Republic.

Methods:
Patients in the early phase of ARDS were enrolled in the study. RM was performed in the CPAP mode for 40 seconds; the aim was to reach transalveolar pressure (Ptrans) of 30 cm H₂O measured by a special bedside respiratory monitoring system.The haemodynamics and blood gases from the pulmonary, radial and hepatic arteries were measured 2 minutes before (preOM), and 2 and 30 minutes after the RM (OM2, OM30). Friedman ANOVA was used for statistical analysis. The data are presented as median and interquartile range.

Results:
Nine ARDS patients were included. During the RM, CPAP of 50 (49–53) and 24 (20–25) cm H₂O was used. Ptrans was reached. MAP decreased by 33% (7–61%) during the RM (P

Conclusion:
During the RM the transalveolar pressure of 30 cm H₂O was not reached in any patient. The RM caused a temporary but significant MAP decrease and did not change oxygenation or the splanchnic circulation.

Key words:
ARDS –⁠ recruitment manoeuvre –⁠ haemodynamics –⁠ splanchnic circulation