Recruitment Maneuver After Intubation

Primary Outcome Measures:

• Oxygenation (PaO2) measured 5 min after the onset of mechanical ventilation [ Time Frame: 5 min after the onset of mechanical ventilation ] [ Designated as safety issue: Yes ]
  

Secondary Outcome Measures:

• PaO2 at 30 min after intubation, hemodynamic and microbiologic safety, ICU length of stay, ICU mortality and mechanical ventilation duration. [ Time Frame: at 30 min after intubation ] [ Designated as safety issue: Yes ]
  

Intervention Details:

Other: Recruitment maneuver

Assigned interventions:

• No intervention after tracheal intubation (control group)
• Alveolar recruitment maneuver (RM group) immediately after intubation

In the intensive care unit (ICU), acute respiratory failure is a common problem. Airway management in critically ill patients usually requires endotracheal intubation after rapid sequence induction. Induction of anesthesia is a well known cause of dramatic changes in respiratory mechanics and gas exchange. Moreover, when the intubation is for respiratory failure, the underlying pathology increases these modifications. The reduction in lung volume results in a deep hypoxemia after intubation. Moreover, mechanical ventilation applied on a collapsed lung increases the risk of ventilator induced lung injury. Recruitment maneuver, which consists of a transient increased in inspiratory pressure, decreases anesthesia-induced lung collapse and hypoxemia. During early acute respiratory failure, RM increases oxygenation and lung volume and may reduce lung oedema. Some authors have suggested the potential benefit of an early RM after induction of anesthesia in operating room. To date, no study has evaluated the short term effect of a recruitment maneuver performed early after intubation in critically ill patients. Therefore, our aim was to ascertain whether RM, performed immediately after intubation, is safe and more effective at reducing hypoxemia than usual management, in hypoxemic patients requiring intubation for invasive ventilation in the ICU.