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Lung recruitment maneuver improves right and left ventricular function in patients with acute respiratory distress syndrome

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dc.contributor.authorLambour, Alexis
dc.contributor.authorZerbib, Yoann
dc.contributor.authorMercado, Pablo
dc.contributor.authorKontar, Loay
dc.contributor.authorDe Cagny, Bertrand
dc.contributor.authorMaizel, Julien
dc.contributor.authorSlama, Michel
dc.contributor.authorBrault, Clément
dc.date.accessioned2026-09-14T20:52:49Z
dc.date.available2026-09-14T20:52:49Z
dc.date.issued2025
dc.description.abstractBACKGROUND: Lung recruitment maneuvers (LRM) and high positive end-expiratory pressure (PEEP) may benefit some patients by reopening non- or poorly aerated alveoli. However, the effects of opening the lung with LRM on hemodynamics remain uncertain. This study aimed to evaluate the direct impact of LRM on cardiac function in patients with moderate-to-severe acute respiratory distress syndrome (ARDS). METHODS: This post-hoc analysis included 34 patients with moderate-to-severe ARDS from two prospective cohort studies. The LRM consisted in a gradual increase in PEEP, starting from 25 cmH2O (PEEPpre, before the recruitment maneuver at PEEP 25 cmH2O) until reaching 40 cmH2O. After LRM, PEEP was decreased to 25 cmH2O (PEEPpost, after the recruitment maneuver, also at PEEP 25 cmH2O) followed by a decremental PEEP titration. We compared the size and function of the right ventricle (RV) and left ventricle (LV) between PEEPpre and PEEPpost. RESULTS: The respiratory system compliance significantly increased from 21 ± 7 ml/cmH2O at PEEPpre to 24 ± 7 ml/cmH2O at PEEPpost (p < 0.001), indicating effective lung recruitment. The RV end-diastolic diameter and the RV/LV ratio decreased after LRM (51 ± 11 vs. 41 ± 9 mm; p < 0.001, and 1.05 ± 0.21 vs. 0.90 ± 0.18; p < 0.001, respectively), suggesting reduced pulmonary vascular resistance. The RV free wall strain improved from -22 ± 10 to -25 ± 8% (p = 0.040). The cardiac index significantly increased from 2.1 ± 0.6 to 2.4 ± 0.7 L/min/m2 (p < 0.001) due to improved LV function, as demonstrated by a lower LV global longitudinal strain at PEEPpost (-16 ± 4% vs. -19 ± 3%, p = 0.002). CONCLUSIONS: LRM may benefit both the lungs and the heart. The increase in transpulmonary pressure leads to an expansion in aerated lung volume, potentially reducing lung overdistension and collapse, thereby lowering RV afterload and improving RV systolic function.
dc.description.versionVersión Publicada
dc.identifier.citationLambour, A., Zerbib, Y., Mercado, P., Kontar, L., Cagny, B., Maizel, J., Slama, M., & Brault, C. (2025). Lung recruitment maneuver improves right and left ventricular function in patients with acute respiratory distress syndrome. BMC pulmonary medicine, 25(1), 274. https://doi.org/10.1186/s12890-025-03735-5
dc.identifier.doihttps://doi.org/10.1186/s12890-025-03735-5
dc.identifier.urihttps://hdl.handle.net/11447/11132
dc.language.isoen
dc.subjectAcute respiratory distress syndrome
dc.subjectHemodynamic
dc.subjectLung recruitability
dc.subjectPositive end-expiratory pressure
dc.subjectRespiratory mechanics
dc.titleLung recruitment maneuver improves right and left ventricular function in patients with acute respiratory distress syndrome
dc.typeArticle
dcterms.accessRightsAcceso Abierto
dcterms.sourceBMC pulmonary medicine
dspace.entity.typePublication
relation.isAuthorOfPublication4e3332b1-7515-4993-8bf0-7a3d87a3a0e4
relation.isAuthorOfPublication.latestForDiscovery4e3332b1-7515-4993-8bf0-7a3d87a3a0e4

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