Study on improvement of recruitment maneuvers and extravascular lung water in oxygenation of high altitude acute respiratory distress syndrome

To understand the improvement of recruitment maneuvers and extravascular lung water in oxygenation of high altitude acute respiratory distress syndrome, 30 HARDS patients were enrolled in the study from May 2012 to October 2013 from Qinghai Provincial People’s Hospital. All the patients received recruitment maneuvers and Pulse Contour Cardiac Output, hemodynamics monitoring including intrathoracic Blood Volume Index; Global End-diastolic Volume Index; Global ejection fraction; Pulmonary Vascular Permeability Index; Extravascular Lung Water Index; Pulse indicates cardiac Index; Stroke Volume Variation; Pulse pressure variation; Maximum pressure to increase speed; Systemic Venous Resistance Index, oxygenation and hemodynamics were determined before and after 72 hours of recruitment maneuvers. The results showed that after treatment with recruitment maneuvers and capacity limitation, PaO₂/FiO₂ was increased significantly compared with those before treatment [PaO₂/FiO₂ (mmHg): 124.70±43.37 vs 186.87±41.20, t=9.43, P<0.001], ITBVI, GEDVI, PVPI, EVLWI, SVV were reduced significantly compared with those before treatment[ITBVI (ml/m²): 1031.00±275.88 vs 907.13±242.56, t=1.26, P=0.041; GEDVI (ml/m²): 822.40±143.30 vs 722.83±169.65, t=1.75, P=0.016; PVPI (ml/kg): 2.71±1.21 vs 1.98±0.65, t=2.86, P=0.001; EVLWI (ml/kg): 12.30±4.19 vs 8.12±2.94, t=8.27, P<0.001; SVV (%):17.30±5.65 vs 10.33±3.47, t=9.17, P<0.001]. Our results indicated that recruitment maneuvers and capacity limitation have been improved oxygenation in HARDS, extravascular lung water reduced, and lung capillary permeability also improved.