الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
In patients with ARDS, protective lung strategy and PEEP therapy should be started as early as possible to avoid lung damage by high pressures, volumes and FiO2. It is interesting to note that high peak pressures ( < 35 cmH2O) along with FiO2 of ≥ 0.5 may damage the pulmonary cells (type I and II) in less than 24 hours.
The protective lung strategy has become a standard in the ventilatory management of patients with ALI/ARDS. The low tidal volumes and pressures advocated for lung protective ventilation has been found to cause progressive de-recruitment of the lung leading to worsening of the hypoxemia. This de-recruitment can be reversed by a recruitment maneuver to open the collapsed alveoli followed by application of a high level of PEEP to keep the alveoli open.
Recruitment is a strategy aiming at re-expanding the collapsed lung tissue through application of a high pressure sufficient to exceed the critical opening pressure of the affected lung tissue and then maintaining an adequate level of PEEP to prevent subsequent de-recruitment.
The present study was carried out to:
1. To evaluate the safety of using a stepwise elevation of PEEP with determination of the optimal PEEP according to the alveolar collapsing pressure as a recruitment maneuver in patients with ARDS ventilated with lung protective strategy.
2. To evaluate the effect of this maneuver on oxygenation and static compliance (Cs) in these patients.
3. To compare between this maneuver and the sustained lung inflation maneuver as regards safety and effectiveness.
This study included 24 patients fulfilling the diagnostic criteria of ARDS. Patients with hemodynamic instability, arrhythmias, heart block, acute coronary syndrome, clinical evidence of left-sided heart failure, previous lung diseases or barotraumas (till insertion of intercostal tube) were excluded. Thorough history was taken. Full clinical assessment, arterial blood gases and chest X-ray were done. LIS was calculated. All included cases were mechanically ventilated according to the lung protective strategy. Patients were enrolled into two groups. Patients in group I have undergone lung recruitment in the form of sustained lung inflation using a PEEP of 30 cmH2O for 30 seconds at FiO2 of 1.0 then they were switched back to there previous sitting of PEEP and FiO2. The maneuver was performed twice with six hours interval. Patients in group II were undergone stepwise elevation of PEEP (5 cmH2O every 2 minutes) up to a level of 25-40 cmH2O followed by progressive decreases of PEEP in steps of 2 cmH2O every 2 minutes until a drop greater than 10 % of the PaO2 of recruitment was identified and considered the alveolar collapsing pressure. The maintenance PEEP was set 2 cmH2O above the alveolar collapsing pressure after reopening of the collapsed alveoli.
The effect of recruitment was evaluated in both groups using the hypoxic index (PaO2/FiO2), lung compliance and radiological infiltrations in the chest X-ray. Complications, success rate and outcome were documented.