Efficacy and safety of an open lung ventilation strategy with staircase recruitment followed by comparison on two different modes of ventilation, in moderate ARDS in cirrhosis: A pilot randomized trial

Goel Vibha; Vandana Saluja; Mitra Lalita Gouri; Kumar Guresh; Aggarwal Prashant; Maiwall Rakhi

doi:10.29390/cjrt-2021-011

Efficacy and safety of an open lung ventilation strategy with staircase recruitment followed by comparison on two different modes of ventilation, in moderate ARDS in cirrhosis: A pilot randomized trial

Can J Respir Ther. 2021 Jul 20:57:105-112. doi: 10.29390/cjrt-2021-011. eCollection 2021.

Authors

Goel Vibha¹, Vandana Saluja¹, Mitra Lalita Gouri¹, Kumar Guresh², Aggarwal Prashant¹, Maiwall Rakhi³

Affiliations

¹ Department of Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India.
² Department of Biostatistics, Institute of Liver and Biliary sciences, New Delhi, India.
³ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.

Abstract

Background: Mechanical ventilation in cirrhosis with acute respiratory distress syndrome (ARDS) is not widely studied. We aimed to study the effect of the staircase recruitment manoeuvre followed by two different modes of ventilation.

Methods: Thirty patients with cirrhosis with moderate ARDS underwent the staircase recruitment manoeuvre followed by randomisation to volume control or pressure control group.

Results: The PaO₂/FiO₂ ratio showed a significant improvement in both the groups after recruitment. The improvement was significantly higher in the pressure control ventilation (PCV) group at the end of the first hour as compared to the volume control ventilation (VCV) group. However, this difference was not significant at the end of 6 and 12 h. In the PCV group it improved from 118.47 ± 10.21 at baseline to 189.87 ± 55.18 12 h post-recruitment. In the VCV group it improved from 113.79 ± 13.22 at baseline to 180.93 ± 81.971. Static lung compliance also improved in both the groups significantly (P < 0.001). The PCV group showed an improvement from 25.42 ± 11.94 mL/cm H₂O at baseline to 29.51 ± 14.58 mL/cm H₂O. In the VCV group the lung compliance improved from 24.78 ± 4.87 mL/cm H₂O to 31.31 ± 10.88 mL/cm H₂O.

Conclusion: This study shows that stepwise recruitment manoeuvre is an effective rescue therapy to improve oxygenation in cirrhosis with moderate ARDS. PCV may have an advantage over VCV in terms of better oxygenation.

Keywords: ARDS; cirrhosis; recruitment; ventilation mode.