Article Document Academic Article Information Content Entity Continuant Continuant Journal Article Entity Entity Generically Dependent Continuant 2025-05-06T10:47:13 RDF description of Intercomparison of recruitment maneuver efficacy in three models of acute lung injury - http://repository.healthpartners.com/individual/document-rn18583 Critical Care Medicine 21544 10.1097/01.ccm.0000147445.73344.3a Animals 2022-02-21T22:48:57.408-06:00 Swine document-rn18583 Risk Factors Pulmonary Gas Exchange <p>OBJECTIVE: To compare the relative efficacy of three forms of recruitment maneuvers in diverse models of acute lung injury characterized by differing pathoanatomy. DESIGN: We compared three recruiting maneuver (RM) techniques at three levels of post-RM positive end-expiratory pressure in three distinct porcine models of acute lung injury: oleic acid injury; injury induced purely by the mechanical stress of high-tidal airway pressures; and pneumococcal pneumonia. SETTING: Laboratory in a clinical research facility. SUBJECTS: Twenty-eight anesthetized mixed-breed pigs (23.8 +/- 2.6 kg). INTERVENTIONS: The RM techniques tested were sustained inflation, extended sigh or incremental positive end-expiratory pressure, and pressure-controlled ventilation. PRIMARY MEASUREMENTS: Oxygenation and end-expiratory lung volume. MAIN RESULTS: The post-RM positive end-expiratory pressure level was the major determinant of post-maneuver PaO2, independent of the RM technique. The pressure-controlled ventilation RM caused a lasting increase of PaO2 in the ventilator-induced lung injury model, but in oleic acid injury and pneumococcal pneumonia, there were no sustained oxygenation differences for any RM technique (sustained inflation, incremental positive end-expiratory pressure, or pressure-controlled ventilation) that differed from raising positive end-expiratory pressure without RM. CONCLUSIONS: Recruitment by pressure-controlled ventilation is equivalent or superior to sustained inflation, with the same peak pressure in all tested models of acute lung injury, despite its lower mean airway pressure and reduced risk for hemodynamic compromise. Although RM may improve PaO2 in certain injury settings when traditional tidal volumes are used, sustained improvement depends on the post-RM positive end-expiratory pressure value.<p> Sensitivity and Specificity Intercomparison of recruitment maneuver efficacy in three models of acute lung injury Positive-Pressure Respiration/*methods Respiration, Artificial 32 public Disease Models, Animal Respiratory Distress Syndrome, /physiopathology/*therapy Respiratory Function Tests Probability Analysis of Variance Pneumonia, Pneumococcal 13482 Respiratory Mechanics/*physiology Lung Compliance Oleic Acid Lung Volume Measurements 12