• Ozgur Komurcu, Burhan Dost, Neslihan Unal, and Fatma Ulger.
• Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
• Niger J Clin Pract. 2022 Aug 1; 25 (8): 1338-1343.

BackgroundThe lung recruitment maneuver (LRM) applied in acute respiratory distress syndrome (ARDS) may increase the intra-cranial pressure (ICP).AimsThis study evaluated the effect of LRM on intra-cranial pressure changes in patients with ARDS by measuring the optic nerve sheath diameter (ONSD).Patients And MethodsLRM was applied to patients undergoing follow-up for ARDS, with a positive pressure of 30 cmH2O for 30 s. ONSD on ultra-sonography, dynamic lung compliance (Cdyn), oxygen saturation (SpO2), and hemodynamic parameters were measured before (T0), immediately after (T1), and 10 min after (T2) LRM. The primary endpoint was the effect of LRM on ONSD changes. The secondary endpoints included the effect of LRM on Cdyn, SpO2 change, and relationship between Cdyn and ONSD changes.ResultsThe study included 60 patients. ONSD was higher at T1 than at T0 (median [interquartile range]: 5.13 [0.4] vs. 5.3 [0.3] mm, P < 0.001) but was similar at T0 and T2 (5.13 [0.4] vs. 5.09 [0.37] mm, P = 0.36). Cdyn and SpO2 were significantly higher at T1 and T2 than at T0 (Cdyn: 22.3 [5.8] vs. 23.7 [7.5] vs. 19.4 [6.6] mL/cmH2O, P < 0.001; SpO2: 90[2] vs. 92[4] vs. 88[4] %, P = 0.013). A significant correlation existed between Cdyn and ONSD changes, which increased at T2 compared to T0 (P < 0.001).ConclusionLRM applied in ARDS causes a short-term increase in ONSD. However, Cdyn increases 10 min after LRM and causes ONSD, thereby leading to a decrease in ICP.

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