Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 1;13(3):853.
doi: 10.3390/jcm13030853.

PEEP-Induced Lung Recruitment Maneuver Combined with Prone Position for ARDS: A Single-Center, Prospective, Randomized Clinical Trial

Lan Lan  1   2 , Yuenan Ni  1   2 , Yubei Zhou  1   2 , Linxi Fu  1   2 , Wentao Wu  1   2 , Ping Li  1   2 , He Yu  1 , Guopeng Liang  1   2 , Fengming Luo  1   2
Affiliations

PEEP-Induced Lung Recruitment Maneuver Combined with Prone Position for ARDS: A Single-Center, Prospective, Randomized Clinical Trial

Lan Lan et al. J Clin Med. .

Abstract

Background: Prone position (PP) and the positive end-expiratory pressure (PEEP)-induced lung recruitment maneuver (LRM) are both efficient in improving oxygenation and prognosis in patients with ARDS. The synergistic effect of PP combined with PEEP-induced LRM in patients with ARDS remains unclear. We aim to explore the effects of PP combined with PEEP-induced LRM on prognosis in patients with moderate to severe ARDS and the predicting role of lung recruitablity. Methods: Patients with moderate to severe ARDS were consecutively enrolled. The patients were prospectively assigned to either the intervention (PP with PEEP-induced LRM) or control groups (PP). The clinical outcomes, respiratory mechanics, and electric impedance tomography (EIT) monitoring results for the two groups were compared. Lung recruitablity (recruitment-to-inflation ratio: R/I) was measured during the PEEP-induced LRM procedure and was used for predicting the response to LRM. Results: Fifty-eight patients were included in the final analysis, among which 28 patients (48.2%) received PEEP-induced LRM combined with PP. PEEP-induced LRM enhanced the effect of PP by a significant improvement in oxygenation (∆PaO2/FiO2 75.8 mmHg vs. 4.75 mmHg, p < 0.001) and the compliance of respiratory system (∆Crs, 2 mL/cmH2O vs. -1 mL/cmH2O, p = 0.02) among ARDS patients. Based on the EIT measurement, PP combined with PEEP-induced LRM increased the ventilation distribution mainly in the dorsal region (5.0% vs. 2.0%, p = 0.015). The R/I ratio was measured in 28 subjects. The higher R/I ratio was related to greater oxygenation improvement after LRM (Pearson's r = 0.4; p = 0.034). Conclusions: In patients with moderate to severe ARDS, PEEP-induced LRM combined with PP can improve oxygenation and dorsal ventilation distribution. R/I can be useful to predict responses to LRM.

Keywords: acute respiratory distress syndrome; electric impedance tomography; prone position; recruitability; recruitment maneuver.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Effects of the prone position combined with the LRM in the intervention group on respiratory mechanics and gas exchanges, compared with the prone position without an LRM in the control group during the first prone position. Effects of the LRM on the peak pressure and mean pressure (A,B), Raw and respiratory compliance (C,D), and PaO2 and PaO2/FiO2 (E,F). * p < 0.05, ** p < 0.01, **** p < 0.0001. ns, not significant.
Figure 3
Figure 3
The changes in Crs, PaO2, and PaO2/FiO2 in intervention groups after PEEP-induced lung recruitments or the control group after 3 h in the prone position (A–C); change in Crs, PaO2, and PaO2/FiO2 in intervention group or control group after being in the prone position (D–F). * p < 0.05, **** p< 0.0001; ns, not significant.
Figure 4
Figure 4
The changes in TV ROI 3 and ROI 4 in the horizonal layers in two groups after the LRM (A). The changes in TV ROI 3 and ROI 4 in the horizonal layers in two groups after the prone position (B). The changes in the ventral and dorsal regional distributions in two groups after the LRM or after 3 h in the prone position (C). The change in the ventral and dorsal regional distributions in the two groups after being in the prone position (D). * p < 0.05.
Figure 5
Figure 5
Kaplan–Meier plot measuring 28 days of the probability of survival.
Figure 6
Figure 6
The changes in TV ROI 3 and ROI 4 in the horizonal layers in R/I > 0.5 and R/I < 0.5 groups after LRMs (A). The changes in TV ROI 3 and ROI 4 in the horizonal layers in the two groups after being in prone positions (B). The changes in ventral and dorsal regional distributions in the two groups after LRMs or 3 h after being in prone positions (C). The changes in ventral and dorsal regional distributions in the two groups after being in prone positions (D). * p < 0.05.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Gorman E.A., O’Kane C.M., McAuley D.F. Acute respiratory distress syndrome in adults: Diagnosis, outcomes, long-term sequelae, and management. Lancet. 2022;400:1157–1170. doi: 10.1016/S0140-6736(22)01439-8. - DOI - PubMed
    1. Meyer N.J., Gattinoni L., Calfee C.S. Acute respiratory distress syndrome. Lancet. 2021;398:622–637. doi: 10.1016/S0140-6736(21)00439-6. - DOI - PMC - PubMed
    1. Bos L.D.J., Ware L.B. Acute respiratory distress syndrome: Causes, pathophysiology, and phenotypes. Lancet. 2022;400:1145–1156. doi: 10.1016/S0140-6736(22)01485-4. - DOI - PubMed
    1. Rampon G.L., Simpson S.Q., Agrawal R. Prone Positioning for Acute Hypoxemic Respiratory Failure and ARDS: A Review. Chest. 2023;163:332–340. doi: 10.1016/j.chest.2022.09.020. - DOI - PubMed
    1. Gattinoni L., Pelosi P., Suter P.M., Pedoto A., Vercesi P., Lissoni A. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am. J. Respir. Crit. Care Med. 1998;158:3–11. doi: 10.1164/ajrccm.158.1.9708031. - DOI - PubMed

LinkOut - more resources