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.	张玮, 宋俊玲, 刘锋涛, 等. 纤维支气管镜下行肺灌洗在治疗创伤性肺不张的临床应用价值[J]. 中国医药科学, 2014, 6(6) : 189-191.
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3.	林辉, 林建东, 廖秀玉. 纤维支气管镜辅助治疗重症呼吸机相关性肺炎的疗效及对呼吸力学指标的影响[J]. 中国老年学杂志, 2015(1) : 50-52.
4.	唐纪文, 陈国胜, 钟耀忠, 等. 纤维支气管镜灌洗治疗昏迷患者合并重症肺部感染的疗效观察[J]. 河北医学, 2015(8) : 1414-1417.
5.	马小彬, 李素清, 陈亚静, 等. 纤维支气管镜在预防老年呼吸机相关性肺炎患者中的应用[J]. 中国老年学杂志, 2012, 32(22) : 4989- 4990.
6.	邢平. 纤维支气管镜在预防呼吸机相关性肺炎患者中的应用[J]. 中国当代医药, 2012, 19(36) : 41-42.
7.	文永康. 肺泡灌洗联合机械通气治疗COPD并呼吸衰竭的分析[J]. 临床肺科杂志, 2013, 18(1) : 27-29.
8.	曾以萍, 汪翠玲. 纤维支气管镜肺泡灌洗治疗医院获得性重症肺炎的疗效分析[J]. 中国医学创新, 2012, 9(35) : 36-37.
9.	陈立春, 叶云飞. 纤维支气管镜灌洗在神经外科昏迷患者救治中的临床应用[J]. 临床医学, 2012, 25(7) : 125-126.
10.	罗旭, 桂水清, 欧阳瑛. 肺复张后递减试验选择最佳呼气末正压的研究[J]. 河北医学, 2010, 16(4) : 390-392.
11.	陆宇翔. 肺开放/复张策略在ICU中的应用研究[J]. 大家健康: 中旬版, 2014, 1(1) : 103-103.
12.	霍志成. 肺复张策略治疗急性呼吸窘迫综合征（ARDS）的临床研究[J]. 国际医药卫生导报, 2011, 17(9) : 1056-1057.
13.	郭永军, 关永东, 孔媛媛, 等. 肺复张策略在急性呼吸窘迫综合症治疗中的作用[J]. 岭南急诊医学杂志, 2012, 17(1) : 47-48.
14.	邢莉. 急性呼吸窘迫综合征肺复张策略的研究进展[J]. 齐齐哈尔医学院学报, 2010, 31(15) : 2451-2453.
15.	李茂琴, 张舟李, 松梅, 等. 肺复张策略后防止肺泡再塌陷的研究 [J]. 中华急诊医学杂志, 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. 肺开放/复张策略研究进展[J]. 内科急危重症杂志, 2007, 13(4) : 153-155.
18.	韩扣兰, 邱海波, 谭焰, 等. 控制性肺膨胀治疗急性呼吸窘迫综合征后最佳PEEP选择[J]. 山东医药, 2009, 49(44) : 34-36.

1. 张玮, 宋俊玲, 刘锋涛, 等. 纤维支气管镜下行肺灌洗在治疗创伤性肺不张的临床应用价值[J]. 中国医药科学, 2014, 6(6) : 189-191.
2. 何亚丽. 纤维支气管镜吸痰联合肺泡灌洗治疗重症肺部感染的疗效评价[J]. 中国现代药物应用, 2014, 8(2) : 105-106.
3. 林辉, 林建东, 廖秀玉. 纤维支气管镜辅助治疗重症呼吸机相关性肺炎的疗效及对呼吸力学指标的影响[J]. 中国老年学杂志, 2015(1) : 50-52.
4. 唐纪文, 陈国胜, 钟耀忠, 等. 纤维支气管镜灌洗治疗昏迷患者合并重症肺部感染的疗效观察[J]. 河北医学, 2015(8) : 1414-1417.
5. 马小彬, 李素清, 陈亚静, 等. 纤维支气管镜在预防老年呼吸机相关性肺炎患者中的应用[J]. 中国老年学杂志, 2012, 32(22) : 4989- 4990.
6. 邢平. 纤维支气管镜在预防呼吸机相关性肺炎患者中的应用[J]. 中国当代医药, 2012, 19(36) : 41-42.
7. 文永康. 肺泡灌洗联合机械通气治疗COPD并呼吸衰竭的分析[J]. 临床肺科杂志, 2013, 18(1) : 27-29.
8. 曾以萍, 汪翠玲. 纤维支气管镜肺泡灌洗治疗医院获得性重症肺炎的疗效分析[J]. 中国医学创新, 2012, 9(35) : 36-37.
9. 陈立春, 叶云飞. 纤维支气管镜灌洗在神经外科昏迷患者救治中的临床应用[J]. 临床医学, 2012, 25(7) : 125-126.
10. 罗旭, 桂水清, 欧阳瑛. 肺复张后递减试验选择最佳呼气末正压的研究[J]. 河北医学, 2010, 16(4) : 390-392.
11. 陆宇翔. 肺开放/复张策略在ICU中的应用研究[J]. 大家健康: 中旬版, 2014, 1(1) : 103-103.
12. 霍志成. 肺复张策略治疗急性呼吸窘迫综合征（ARDS）的临床研究[J]. 国际医药卫生导报, 2011, 17(9) : 1056-1057.
13. 郭永军, 关永东, 孔媛媛, 等. 肺复张策略在急性呼吸窘迫综合症治疗中的作用[J]. 岭南急诊医学杂志, 2012, 17(1) : 47-48.
14. 邢莉. 急性呼吸窘迫综合征肺复张策略的研究进展[J]. 齐齐哈尔医学院学报, 2010, 31(15) : 2451-2453.
15. 李茂琴, 张舟李, 松梅, 等. 肺复张策略后防止肺泡再塌陷的研究 [J]. 中华急诊医学杂志, 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. 肺开放/复张策略研究进展[J]. 内科急危重症杂志, 2007, 13(4) : 153-155.
18. 韩扣兰, 邱海波, 谭焰, 等. 控制性肺膨胀治疗急性呼吸窘迫综合征后最佳PEEP选择[J]. 山东医药, 2009, 49(44) : 34-36.

West China Medical Journal

Comparative Study of Recruitment Maneuver in Mechanically Ventilated Patients after Fibrobronchoscopy

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