Recruitment Maneuver After Intubation

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the safety and efficacy of a recruitment maneuver immediately after intubation in hypoxemic patients.

Detailed Description
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In the intensive care unit (ICU), acute respiratory failure is a common problem. Airway management in critically ill patients usually requires endotracheal intubation after rapid sequence induction. Induction of anesthesia is a well known cause of dramatic changes in respiratory mechanics and gas exchange. Moreover, when the intubation is for respiratory failure, the underlying pathology increases these modifications. The reduction in lung volume results in a deep hypoxemia after intubation. Moreover, mechanical ventilation applied on a collapsed lung increases the risk of ventilator induced lung injury. Recruitment maneuver, which consists of a transient increased in inspiratory pressure, decreases anesthesia-induced lung collapse and hypoxemia. During early acute respiratory failure, RM increases oxygenation and lung volume and may reduce lung oedema. Some authors have suggested the potential benefit of an early RM after induction of anesthesia in operating room. To date, no study has evaluated the short term effect of a recruitment maneuver performed early after intubation in critically ill patients. Therefore, our aim was to ascertain whether RM, performed immediately after intubation, is safe and more effective at reducing hypoxemia than usual management, in hypoxemic patients requiring intubation for invasive ventilation in the ICU.

Official Title
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Recruitment Maneuver Increases Oxygenation After Intubation in Hypoxemic ICU Patients: a Randomized Controlled Study

Conditions
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Hypoxemia

Intervention / Treatment
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* Other: Recruitment maneuver


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adults who met acute respiratory failure requiring intubation adults who met hypoxemia, defined by a PaO2 less than 100 mm Hg under a high FiO2 mask driven by at least 10 L/min oxygen. Exclusion Criteria: encephalopathy coma cardiac resuscitation hyperkaliemia (>5.5 mEq/L) acute brain injury and recent thoracic surgery

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Recruitment maneuver|Assigned interventions: No intervention after tracheal intubation (control group) Alveolar recruitment maneuver (RM group) immediately after intubation|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Oxygenation (PaO2) measured 5 min after the onset of mechanical ventilation |  | 5 min after the onset of mechanical ventilation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PaO2 at 30 min after intubation, hemodynamic and microbiologic safety, ICU length of stay, ICU mortality and mechanical ventilation duration. |  | at 30 min after intubation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Intubation, Hypoxemia, Mechanical ventilation, Recruitment maneuver, Acute lung injury, Bacterial translocation, Hypoxemic ICU patients requiring invasive mechanical ventilation