Alveolar Recruitment Maneuver During Cesarean Section Improves Lung Compliance
Condition: Decreased Lung Compliance; Hypoxia; Hypercapnia; Atelectasis; Pneumonia
MeSH terms: Pulmonary Atelectasis; Hypoxia; Hypercapnia
Study type: Interventional
Phase: Phase 2

Summary: 
      The investigators tested the hypothesis that alveolar recruitment maneuver during cesarean
      section and in women under general anesthesia improves lung compliance and gas exchange. The
      investigators applied recruitment maneuver and positive end expiratory pressure (PEEP) 8
      cmH2O. The maximum alveolar pressure limit (Ppeak)was 45 cmH2O during the recruitment
      maneuver. The primary end point of the study is the improvement of the lung compliance
      measured as volume difference/pressure difference (dv/dp) or ml/cmH2O
    

Detailed description: 
      The investigators used recruitment maneuver during cesarean section and in women under
      general anesthesia. The primary end point of the study is the improvement of the lung
      compliance measured as volume difference/pressure difference (dv/dp) or ml/cmH2O after the
      recruitment maneuver. The investigators used 2 groups of patients. In the first group the
      investigators used pressure control ventilation for the recruitment maneuver. After the
      ventilator was switched to pressure control mode the investigators increased the inspiratory
      time to 50% and the inspiratory pressure above Positive End Expiratory Pressure (Ppeak) to 20
      cmH2O. Then the investigators progressively increased Positive End Expiratory Pressure (PEEP)
      to have a peak inspiratory pressure (Ppeak) to 45 cm H2O. The whole recruitment maneuver
      lasts 2 minutes. After the recruitment maneuver the investigators used volume control
      ventilation again (with the baseline settings)and PEEP step wised decreased to 8 cmH20but.
      PEEP (8cmH2O) was left until the end of the operation. In the second group the investigators
      did not used lung recruitment maneuver at all. In both groups lung compliance was measured
      (dynamic and static)as dv/dp (ml/cmH2O). Measures were assessed 1 minute after delivery (but
      before recruitment), 3 minutes after recruitment (first group) at 10 and at 20 minutes after
      recruitment. The investigators also measured Ppeak (cmH2O) and Pplateau (cmH2O)inspiratory
      pressures , blood pressure (mmHG), beats per minute, oxygen saturation, end-tidal CO2
      according to the above time frame, blood Gases before and 3 minutes after recruitment etc.
    

Intervention name(s): Alveolar Recruitment maneuver
Intervention type(s): Procedure
Intervention description(s): In this group and during recruitment maneuver the investigators used pressure control ventilation and increased inspiratory time to 50%. The investigators used alveolar recruitment maneuver by increasing inspiratory pressure to 20 cmH20 and progressively increasing Positive Expiratory Pressure (PEEP) up to 45 cmH2O maximal (Ppeak) inspiratory pressure. The recruitment maneuver lasted 2 minutes. After the maneuver PEEP was set to 8 cmH2O and was left until the end of the operation. After the end of the recruitment maneuver volume control ventilation was used until the end of the operation too.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Care Provider, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Lung recruitment, cesarean, lung compliance, atelectasis