• Gianmaria Cammarota, Rosanna Vaschetto, Emilia Turucz, Fabrizio Dellapiazza, Davide Colombo, Cristiana Blando, Della CorteFrancescoF, Salvatore Maurizio Maggiore, and Paolo Navalesi.
• Università del Piemonte Orientale Amedeo Avogadro-Alessandria-Novara-Vercelli, Dipartimento di Medicina Clinica e Sperimentale, Anesthesia and Intensive Care, University Hospital Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy.
• Intensive Care Med. 2011 Jul 1; 37 (7): 1095-102.

PurposeNoninvasive continuous positive airway pressure (n-CPAP) has been proposed for the treatment of hypoxemic acute respiratory failure (h-ARF). Recruitment maneuvers were shown to improve oxygenation, i.e., the ratio of arterial oxygen tension to inspiratory oxygen fraction (PaO2/FiO2), during either invasive mechanical ventilation, and n-CPAP, with a response depending on the distribution of lung collapse. We hypothesized that, during n-CPAP, early h-ARF patients with bilateral (B(L)) distribution of lung involvement would benefit from recruitment maneuvers more than those with unilateral (U(L)) involvement.MethodsTo perform a recruitment maneuver, once a minute we increased the pressure applied to the airway from 10 cmH2O to 25 cmH2O for 8 s (SIGH). We enrolled 24 patients with h-ARF (12 B(L) and 12 U(L)) who underwent four consecutive trials: (1) 30 min breathing through a Venturi mask (V(MASK)), (2) 1 h n-CPAP (n-CPAP1), (3) 1 h n-CPAP plus SIGH (n-CPAP(SIGH)), and (4) 1 h n-CPAP (n-CPAP2).ResultsCompared to V(MASK), n-CPAP at 10 cmH2O delivered via a helmet, increased PaO2/FiO2 and decreased dyspnea in both B(L) and U(L); furthermore, it reduced the respiratory rate and brought PaCO2 up to normal in B(L) only. Compared to n-CPAP, n-CPAP(SIGH) significantly improved PaO2/FiO2 in B(L) (225 ± 88 vs. 308 ± 105, respectively), whereas it produced no further improvement in PaO2/FiO2 in U(L) (232 ± 72 vs. 231 ± 77, respectively). SIGH did not affect hemodynamics in both groups.ConclusionsCompared to n-CPAP, n-CPAP(SIGH) further improved arterial oxygenation in B(L) patients, whereas it produced no additional benefit in those with U(L).

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