Comparative Study of Recruitment Maneuver in Mechanically Ventilated Patients after Fibrobronchoscopy_West China Medical Journal

Authors：

 LiuXiaoyi , ZhengXiangde , LiuHui

Intensive Care Unit, Dazhou Central Hospital, Dazhou, Sichuan 635000, P. R. China;

Corresponding?author：

Keywords：

Invasive mechanical ventilation; Fibrobronchoscope; Recruitment maneuvers; Obstructive pulmonary atelectasis; Difficulty offline

DOI：

10.7507/1002-0179.201600235

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Objective To investigate the effect of recruitment maneuver (RM) following fibrobronchoscopy in invasively mechanically ventilated (IMV) patients with excessive airway secretions or foreign body aspiration. Methods From September 2012 to July 2014, 200 eligible patients were randomly assigned to intervention group (n=100) and control group (n=100) . Airway clearance by fibrobronchoscopy was conducted in both the two groups, but RM was subsequently performed only in the intervention group. Outcome measurements included oxygenation index, partial pressure of carbon dioxide (PaCO₂), heart rate (HR), air way resistance (Raw) and dynamic lung compliance (Cdyn) before and 2 hours after treatment, and duration of IMV and Intensive Care Unit (ICU) stay were also analyzed. Results After treatment with fibrobronchoscopy, oxygenation index [intervention vs. control: (291.14±38.49) vs. (241.39± 35.62) mm Hg (1 mm Hg=0.133 kPa)], PaCO₂ [(41.65±7.73) vs. (38.87±7.97) mm Hg] and Cdyn [(48.94±11.21) vs. (39.59±10.98) mL/cm H₂O (1 cm H₂O=0.098 kPa) ] were significantly increased, while HR [(95.41±20.59) , vs. (106.47±19.11) beats/min] and Raw [(17.87±8.32) vs. (23.98±7.88) cm H₂O/(L·s)] were significantly decreased in both groups (P ＜ 0.01) . Duration of IMV and ICU stay in the intervention group were (15.72±6.42) and (19.85±8.12) days respectively, while in the control group were (20.49±7.21) and (27.87±10.33) days. Compared with the control group, patients in the intervention group had lower Raw, duration of IMV and ICU stay, and higher Cdyn, oxygenation index, and PaCO₂ (P ＜ 0.01) , but no significant difference was found in HR (P ＞ 0.05) . Conclusion In mechanically ventilated patients with excessive airway secretion or foreign body aspiration, recruitment maneuver following fibrobronchoscopy is of great clinical importance, due to the decrease of the duration of mechanical ventilation and ICU stay by re-inflating the collapsing alveoli, improving pulmonary ventilation and gas exchange, lung compliance and diffusion capacity.

Citation： LiuXiaoyi, ZhengXiangde, LiuHui. Comparative Study of Recruitment Maneuver in Mechanically Ventilated Patients after Fibrobronchoscopy. West China Medical Journal, 2016, 31(5): 863-866. doi: 10.7507/1002-0179.201600235 Copy

1.	張瑋, 宋俊玲, 劉鋒濤, 等. 纖維支氣管鏡下行肺灌洗在治療創傷性肺不張的臨床應用價值[J]. 中國醫藥科學, 2014, 6(6) : 189-191.
2.	何亞麗. 纖維支氣管鏡吸痰聯合肺泡灌洗治療重癥肺部感染的療效評價[J]. 中國現代藥物應用, 2014, 8(2) : 105-106.
3.	林輝, 林建東, 廖秀玉. 纖維支氣管鏡輔助治療重癥呼吸機相關性肺炎的療效及對呼吸力學指標的影響[J]. 中國老年學雜志, 2015(1) : 50-52.
4.	唐紀文, 陳國勝, 鐘耀忠, 等. 纖維支氣管鏡灌洗治療昏迷患者合并重癥肺部感染的療效觀察[J]. 河北醫學, 2015(8) : 1414-1417.
5.	馬小彬, 李素清, 陳亞靜, 等. 纖維支氣管鏡在預防老年呼吸機相關性肺炎患者中的應用[J]. 中國老年學雜志, 2012, 32(22) : 4989- 4990.
6.	邢平. 纖維支氣管鏡在預防呼吸機相關性肺炎患者中的應用[J]. 中國當代醫藥, 2012, 19(36) : 41-42.
7.	文永康. 肺泡灌洗聯合機械通氣治療COPD并呼吸衰竭的分析[J]. 臨床肺科雜志, 2013, 18(1) : 27-29.
8.	曾以萍, 汪翠玲. 纖維支氣管鏡肺泡灌洗治療醫院獲得性重癥肺炎的療效分析[J]. 中國醫學創新, 2012, 9(35) : 36-37.
9.	陳立春, 葉云飛. 纖維支氣管鏡灌洗在神經外科昏迷患者救治中的臨床應用[J]. 臨床醫學, 2012, 25(7) : 125-126.
10.	羅旭, 桂水清, 歐陽瑛. 肺復張后遞減試驗選擇最佳呼氣末正壓的研究[J]. 河北醫學, 2010, 16(4) : 390-392.
11.	陸宇翔. 肺開放/復張策略在ICU中的應用研究[J]. 大家健康: 中旬版, 2014, 1(1) : 103-103.
12.	霍志成. 肺復張策略治療急性呼吸窘迫綜合征（ARDS）的臨床研究[J]. 國際醫藥衛生導報, 2011, 17(9) : 1056-1057.
13.	郭永軍, 關永東, 孔媛媛, 等. 肺復張策略在急性呼吸窘迫綜合癥治療中的作用[J]. 嶺南急診醫學雜志, 2012, 17(1) : 47-48.
14.	邢莉. 急性呼吸窘迫綜合征肺復張策略的研究進展[J]. 齊齊哈爾醫學院學報, 2010, 31(15) : 2451-2453.
15.	李茂琴, 張舟李, 松梅, 等. 肺復張策略后防止肺泡再塌陷的研究 [J]. 中華急診醫學雜志, 2007, 16(4) : 431-433.
16.	Keith G. Reinterpreting the pressure-volume curve in patients with acute resiratory distress syndrome[J]. Crit Care, 2002, 8(1) : 32-38.
17.	殷娜, 宋志芳. 肺開放/復張策略研究進展[J]. 內科急危重癥雜志, 2007, 13(4) : 153-155.
18.	韓扣蘭, 邱海波, 譚焰, 等. 控制性肺膨脹治療急性呼吸窘迫綜合征后最佳PEEP選擇[J]. 山東醫藥, 2009, 49(44) : 34-36.

1. 張瑋, 宋俊玲, 劉鋒濤, 等. 纖維支氣管鏡下行肺灌洗在治療創傷性肺不張的臨床應用價值[J]. 中國醫藥科學, 2014, 6(6) : 189-191.
2. 何亞麗. 纖維支氣管鏡吸痰聯合肺泡灌洗治療重癥肺部感染的療效評價[J]. 中國現代藥物應用, 2014, 8(2) : 105-106.
3. 林輝, 林建東, 廖秀玉. 纖維支氣管鏡輔助治療重癥呼吸機相關性肺炎的療效及對呼吸力學指標的影響[J]. 中國老年學雜志, 2015(1) : 50-52.
4. 唐紀文, 陳國勝, 鐘耀忠, 等. 纖維支氣管鏡灌洗治療昏迷患者合并重癥肺部感染的療效觀察[J]. 河北醫學, 2015(8) : 1414-1417.
5. 馬小彬, 李素清, 陳亞靜, 等. 纖維支氣管鏡在預防老年呼吸機相關性肺炎患者中的應用[J]. 中國老年學雜志, 2012, 32(22) : 4989- 4990.
6. 邢平. 纖維支氣管鏡在預防呼吸機相關性肺炎患者中的應用[J]. 中國當代醫藥, 2012, 19(36) : 41-42.
7. 文永康. 肺泡灌洗聯合機械通氣治療COPD并呼吸衰竭的分析[J]. 臨床肺科雜志, 2013, 18(1) : 27-29.
8. 曾以萍, 汪翠玲. 纖維支氣管鏡肺泡灌洗治療醫院獲得性重癥肺炎的療效分析[J]. 中國醫學創新, 2012, 9(35) : 36-37.
9. 陳立春, 葉云飛. 纖維支氣管鏡灌洗在神經外科昏迷患者救治中的臨床應用[J]. 臨床醫學, 2012, 25(7) : 125-126.
10. 羅旭, 桂水清, 歐陽瑛. 肺復張后遞減試驗選擇最佳呼氣末正壓的研究[J]. 河北醫學, 2010, 16(4) : 390-392.
11. 陸宇翔. 肺開放/復張策略在ICU中的應用研究[J]. 大家健康: 中旬版, 2014, 1(1) : 103-103.
12. 霍志成. 肺復張策略治療急性呼吸窘迫綜合征（ARDS）的臨床研究[J]. 國際醫藥衛生導報, 2011, 17(9) : 1056-1057.
13. 郭永軍, 關永東, 孔媛媛, 等. 肺復張策略在急性呼吸窘迫綜合癥治療中的作用[J]. 嶺南急診醫學雜志, 2012, 17(1) : 47-48.
14. 邢莉. 急性呼吸窘迫綜合征肺復張策略的研究進展[J]. 齊齊哈爾醫學院學報, 2010, 31(15) : 2451-2453.
15. 李茂琴, 張舟李, 松梅, 等. 肺復張策略后防止肺泡再塌陷的研究 [J]. 中華急診醫學雜志, 2007, 16(4) : 431-433.
16. Keith G. Reinterpreting the pressure-volume curve in patients with acute resiratory distress syndrome[J]. Crit Care, 2002, 8(1) : 32-38.
17. 殷娜, 宋志芳. 肺開放/復張策略研究進展[J]. 內科急危重癥雜志, 2007, 13(4) : 153-155.
18. 韓扣蘭, 邱海波, 譚焰, 等. 控制性肺膨脹治療急性呼吸窘迫綜合征后最佳PEEP選擇[J]. 山東醫藥, 2009, 49(44) : 34-36.

West China Medical Journal

Comparative Study of Recruitment Maneuver in Mechanically Ventilated Patients after Fibrobronchoscopy

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