Validation of lung sonography in the implementation of open lung strategy as a recruitment maneuver versus traditional sustained inflation in acute respiratory distress syndrome patients

Abstract

Introduction Acute respiratory distress syndrome (ARDS) is a serious problem in critically ill patients with high mortality rates. Lung recruitment maneuvers (RM) are important in the treatment of ARDS with an aim to improve oxygenation. There are many approved methods for lung recruitment like the traditional sustained inflation technique and the stepladder positive end-expiratory pressure (PEEP) titration technique. The traditional methods to evaluate RM like computed tomography and pressure–volume curves showed some limitation and disadvantages. Thus, bedside ultrasonography (US) could be a safe bedside tool to evaluate lung aeration and the effectiveness of RM defining the optimum PEEP needed and preventing lung overdistension. Aim To evaluate the usefulness of lung US as a guide to follow up RM by PEEP titration technique in comparison to sustained inflation technique. Patients and methods In all, 40 ARDS patients were segregated into two groups: group 1 included 20 patients who were subjected to traditional sustained inflation RM and group 2 included 20 patients were subjected to sonar-guided lung recruitment. US scoring, PO2, PO2/FiO2, and lung compliance were used to evaluate the pulmonary recruitment end point defining the best PEEP. Results Lung compliance, PO2, and PO2/FiO2 were significantly increased after RM in both groups (P<0.05); however, there was no statistically significant difference between the two groups. The best PEEP in group 1 and group 2 were 20.60±3.485 and 15.90±5.340, respectively, with a significant difference between the two groups (P=0.002). There was no statically significant difference between the two groups regarding complication, vent days and ICU days. Conclusion Bedside US can be very useful in the evaluation and management of mechanically ventilated patients in ICUs and to guide the RM in ARDS patients. There is no significant difference between the sustained inflation RM and the sonar-guided stepwise PEEP titration RM regarding oxygenation and compliance except for the level of PEEP reached, which is lower in the stepwise PEEP titration group giving less potentiality for complications.