Effects of Recruitment Maneuvers in Early Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) Patients

LUN WEI LIU

Status: Completed

Conditions: Acute Respiratory Distress Syndrome; Lung Injury, Acute

Treatments: Procedure: Lung protective strategy group; Procedure: Lung recruitment maneuver

Study type: Interventional

Funder types: Other

Identifiers

NCT01114009

CLFHR9803

Details and patient eligibility

About

The purpose of this study is to evaluate the effect of lung recruitment maneuver in patients with early ALI/ARDS

Full description

The acute respiratory distress syndrome (ARDS) was first described in the medical literature in 1967. Patients with ARDS mostly require mechanical ventilatory support due to hypoxic respiratory failure. Mechanical ventilation can induce lung injury (ventilator-induced lung injury, VILI) by causing overdistention and repetitive opening and closing of unstable lung units. Data from a number of randomized controlled trials indicate that a lung protective ventilatory strategy with small tidal volume and low plateau pressure reduces mortality in acute lung injury (ALI) and acute respiratory distress syndrome. Lung recruitment maneuvers are being used in the management of ALI and ARDS, but recruitment maneuvers are still controversial. Lung recruitment maneuver is aimed to open the collapsed lung and keep the lung open. The maneuver briefly increases the alveolar pressure to open recruitable lung, sustained with adequate positive end-expiratory pressure(PEEP) after lung recruitment, to avoid derecruitment. We want to enroll 120 patients with early ALI/ARDS in this randomized controlled study. The study group use recruitment maneuver and lung protective ventilatory strategy, and the control group use lung protective ventilatory strategy only. Concerning about both safety and efficacy, we design a modified recruitment maneuver protocol which has never been published in previous medical literature. The primary outcome is ventilator-free days and ICU-free days, and secondary outcomes include ventilator weaning rate, and 28-day mortality and cost effectiveness analysis. Since no randomized controlled trials clearly establish benefit from recruitment maneuvers, we hope this study would be able to provide some evidence on whether lung recruitment should be used in the routine management of ALI/ARDS.

Enrollment: 120 patients

Sex: All

Ages: 19+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• met criteria of ALI/ARDS
• PaO2/FiO2 less than or equal 250 mmHg after standard ventilator setting (FiO2 more than or equal 0.5 and PEEP more than or equal 10 cmH2O)at least 30 mins

Exclusion criteria

• age less than 18 years
• duration of mechanical ventilator more than 72 hours
• Pneumothorax or subcutaneous emphysema or bullous lung disease
• severe chronic respiratory disease
• intracranial hypertension or received craniotomy surgery
• longterm dependent ventilator
• Neuromuscular disease
• premorbid conditions with an expected 6 month mortality risk exceeding 50%

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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120 participants in 2 patient groups

Lung recruitment maneuver

Experimental group

Description:

The maneuver briefly increases the alveolar pressure to open recruitable lung (50 cmH2O), sustained with adequate positive end-expiratory pressure(PEEP) after lung recruitment, to avoid derecruitment.

Treatment:

Procedure: Lung recruitment maneuver

Procedure: Lung protective strategy group

Lung protective strategy

Active Comparator group

Description:

Lung protective strategy group received lung protective strategy without recruitment maneuver

Treatment:

Procedure: Lung protective strategy group