• Sérgio N Nemer, Jefferson B Caldeira, Leandro M Azeredo, João Márcio Garcia, Ricardo T Silva, Darwin Prado, Ricardo G Santos, Bruno S Guimarães, Rodrigo A Ramos, Rosângela A Noé, and Paulo Cesar P Souza.
• Hospital de Clínicas de Niterói, Rua La Salle 12, Centro, Niterói, Rio de Janeiro 24020-090, Brazil. snnemer@urbi.com.br
• J Crit Care. 2011 Feb 1;26(1):22-7.

PurposeThe purpose of the study was to compare 2 alveolar recruitment maneuvers (ARMs) approaches in patients with subarachnoid hemorrhage (SAH) and acute respiratory distress syndrome (ARDS).Material And MethodsSixteen SAH patients with ARDS were randomized in 2 similar groups. One received ARM with continuous positive airway pressure (CPAP) of 35 cm H(2)O for 40 seconds (CPAP recruitment), whereas the other received pressure control ventilation with positive-end expiratory pressure of 15 cm H(2)O and pressure control above positive end-expiratory pressure of 35 cm H(2)O for 2 minutes (pressure control recruitment maneuver [PCRM]). Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were measured before and after ARM. The ratio of arterial oxygen tension to fraction of inspired oxygen was measured before and 1 hour after the ARM.ResultsAfter ARM, ICP was higher in CPAP recruitment (20.50 ± 4.75 vs 13.13 ± 3.56 mm Hg; P = .003); and CPP was lower in CPAP recruitment (62.38 ± 9.81 vs 79.60 ± 6.8 mm Hg; P = .001). One hour after the ARM, the ratio of arterial oxygen tension to fraction of inspired oxygen increased significantly only in PCRM (108.5 to 203.6; P = .0078).ConclusionIn SAH patients with ARDS, PCRM did not affect ICP and decreased CPP in safe levels, besides improving oxygenation.Copyright © 2011. Published by Elsevier Inc.

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