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CRITICAL CARE AND TRAUMA

Selective Recruitment Maneuvers for Lobar Atelectasis: Effects on Lung Function and Central Hemodynamics: An Experimental Study in Pigs

Lars Kjærsgaard Hansen, MD^*, Erik Sloth, MD, PhD, Jonas Nielsen, MD, Jacob Koefoed-Nielsen, MD^*, Per Lambert, MD^*, Søren Lunde, MS, and Anders Larsson, MD, PhD^*

*Department of Anesthesia and Intensive Care Medicine, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospitals, Aalborg, Denmark; Clinical Institute, Aarhus University, Århus, Denmark; Department of Anesthesia and Intensive Care Medicine, Skejby Hospital, Aarhus University Hospitals, Århus, Denmark; and Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital Gentofte, Hellerup, Denmark

Address correspondence to Anders Larsson, MD, PhD, Department of Anesthesia and Intensive Care Medicine, Aalborg Hospital, Århus University Hospitals, Hobrovej 18-22, DK 9000 Denmark. Address e-mail to an.larsson{at}nja.dk.

We investigated whether selective lung recruitment of a lobar collapse would improve oxygenation and lung volume as well as a general (global) lung recruitment maneuver, with fewer circulatory side effects. In 10 ventilated, anesthetized pigs, a bronchial blocker was inserted in the right lower lobe, which was selectively lavaged to create a dense lobar collapse. The pigs were randomized into two orders of lung recruitment maneuvers (40 cm H₂O airway pressure for 30 s): either a selective lung recruitment maneuver (using the inner lumen of the bronchial blocker) followed by a general lung recruitment maneuver, or vice versa. Median end-expiratory lung volume and median Pao₂ increased significantly by approximately 100 mL and 16 kPa, respectively, with no significant differences between the two recruitment methods. There were no circulatory changes during the selective lung recruitment maneuver, but during the general lung recruitment maneuver, mean arterial blood pressure decreased significantly by 36 (21, 41) mm Hg (median, 25th and 75th percentiles), cardiac output by 2.1 (1.6, 2.5) L/min and left ventricular end-diastolic area by 4.4 (3.5, 4.5) cm². In conclusion, a selective recruitment maneuver improved lung function similar to a general lung recruitment maneuver but without any circulatory side effects.

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