Efficacy analysis of the lung recruitment maneuver in correcting pulmonary atelectasis in neurological intensive care unit-a retrospective study

Abstract

Background: Atelectasis after supratentorial craniotomy is common. It can lead to the decrease of arterial partial pressure of oxygen (PaO₂) in patients with neurosurgical intensive care units (NICU), and the recovery of neurological function is more and more difficult. However, due to the particularity of maintaining the stability of intracranial pressure (ICP), there are few reports on effective ways to alleviate atelectasis and improve oxygenation in patients with NICU effectively.

Methods: A retrospective analysis was conducted to analyze the clinical data of patients with atelectasis who received lung recruitment maneuver in the NICU. This study collected data on 33 patients. Of these, 17 patients had traumatic brain injury and 16 patients had spontaneous intracranial hemorrhage. PaO₂, oxygenation index (OI), tidal volume, positive end-expiratory pressure (PEEP), respiratory system compliance, plateau pressure, respiratory rate, minute ventilation and chest computed tomography (CT) or portable chest X-ray images were compared before and after recruitment. As for safety evaluation indicators, we reviewed the invasive arterial blood pressure, heart rate, heart rhythm, and subcutaneous emphysema in all patients. Before and after lung recruitment, the data were compared using the paired t-test and the Wilcoxon test.

Results: Compared with tidal volume 8.1 [6.85-10.05] mL/kg, minute ventilation volume (9.3±1.3 L/min), respiratory system compliance 60 [39-80] mL/cmH₂O, respiratory rate 17 [16-21.5] breaths/min, PEEP 4 [4-6] cmH₂O, plateau pressure 19 [17-23] cmH₂O, PaO₂ (104.2±33.17 mmHg) and OI (250.6±87.65 mmHg) before lung recruitment, tidal volume 9 [8.05-10.65] mL/kg, minute ventilation (9.7±1.1 L/min), respiratory system compliance 69 [50-82.5] mL/cmH₂O, respiratory rate 17 [14-18.5] breaths/min, PEEP 4 [4-5] cmH₂O, plateau pressure 18 [16-19.5] cmH₂O, PaO₂ (127.3±34.95 mmHg) and OI (306.9±96.52 mmHg) of patients were significantly improved after recruitment after recruitment (all P<0.05). In all patients, chest CT showed a decrease in atelectasis area and bilateral pulmonary exudates in 25 patients after lung recruitment maneuver. X-ray after recruitment in 2 patients showed increased lung tissue transparency and decreased ground-glass shadowing, while improvements were not obvious in 6 patients.

Conclusions: For patients diagnosed with atelectasis in the NICU, lung recruitment maneuver can improve atelectasis, increase PaO₂, and improve oxygenation.

Keywords: Lung recruitment maneuver; oxygenation index (OI); pulmonary atelectasis; spontaneous intracranial hemorrhage; traumatic brain injury.