Comment on 'Lung recruitment maneuver depresses central hemodynamics in patients after cardiac surgery' by Nielsenet al. and 'Acute leftward septal shift by lung recruitment maneuver' by Jardin.

摘要

We read with great interest the recent contribution by Nielsen et al. and accompanying editorial by Jardin . In their manuscript Nielsen et al. studied the hemodynamic impact of 10-20 s of 40 cm H2O CPAP immediately after cardiac surgery. They monitored continuously the left ventricular short axis view by transesophageal echocardiography, pulse contour cardiac output, and arterial pressure. They reported that in ten patients both left ventricular end-diastolic areas and cardiac output (CO) decreased during recruitment maneuvers (RMs), and that these returned to 90% of baseline values within 60min after RMs. They concluded that the indication for RMs should be very strict and should be applied with caution in such patients. We agree almost completely with Nielsen et al.; however, the clinical- impact of this short period of CO decreases, and the effects on hemodynamic parameters of differenttypes of RMs (such as sigh) must be studied in this and other groups of patients. In the related editorial Jardinstates that, "I do not know why intensivists dealing with mechanical ventilation in ARDS are so fanatic about 'recruitment.. They totally forget a very simple fact: even if poorly aerated, a damaged lung with a preserved circulation will survive. Conversely, a maximally aerated lung without any circulation is a useless organ."