The Effect of Recruitment Maneuvers on Dead Space in Patients with ARDS: Prospective Observational Study

Year 2026, Volume: 8 Issue: 1 , 5 - 10 , 31.03.2026

Ayla Esin , Tuğhan Utku , Oktay Demirkiran , Seval Ürkmez , Yalım Dikmen

https://doi.org/10.38175/phnx.1749197

https://izlik.org/JA89JU43SM

Abstract

Objective: Acute Respiratory Distress Syndrome (ARDS) is characterized by severe hypoxemia and heterogeneous lung involvement. Recruitment maneuvers (RMs) and positive end-expiratory pressure (PEEP) titration are commonly employed strategies in lung-protective ventilation to reopen collapsed alveoli and improve oxygenation. However, the effect of these strategies on dead space—a key indicator of ventilation-perfusion mismatch—remains underexplored. This study aimed to investigate the impact of RMs and PEEP titration on dead space in patients with ARDS.
Material and Method: This prospective observational study included twelve early-phase ARDS patients. After initial stabilization, each patient underwent a standard RM protocol followed by decremental PEEP titration. Dead space parameters, lung mechanics, blood gases, and hemodynamic variables were measured before and after RM and individualized PEEP titration.
Results: A statistically significant reduction in both airway and physiological dead space was observed following RM. PaO₂ and oxygen saturation increased, while arterial pH decreased modestly. Alveolar dead space, compliance, airway pressures, end-tidal CO₂, and hemodynamics did not change significantly.
Conclusion: Individualized ventilation strategies with RMs and PEEP may reduce physiological dead space and improve oxygenation in early ARDS without causing significant hemodynamic compromise. These findings suggest that incorporating dead space monitoring could be considered in personalized approaches to help optimize gas exchange and potentially improve clinical outcomes

Keywords

Acute Respiratory Distress Syndrome (ARDS) , Dead space , Recruitment maneuver , PEEP , Mechanical ventilation , Respiratory mechanics , Ventilation-Perfusion ratio

Supporting Institution

yok

ARDS Hastalarında Recruitment Manevralarının Ölü Boşluk Üzerine Etkisi: Prospektif Gözlemsel Çalışma

https://izlik.org/JA89JU43SM

Abstract

Amaç: Akut Solunum Sıkıntısı Sendromu (ARDS), şiddetli hipoksemi ve heterojen akciğer tutulumuyla karakterizedir. Rekruitman manevraları (RM) ve pozitifi son ekspiryum basıncı (PEEP) titrasyonu, kollabe alveollerin yeniden açılmasını sağlamak ve oksijenasyonu artırmak amacıyla akciğer koruyucu ventilasyon stratejileri kapsamında yaygın olarak kullanılmaktadır. Ancak, bu stratejilerin ventilasyon-perfüzyon uyumsuzluğunun önemli bir göstergesi olan ölü boşluk üzerine etkisi yeterince araştırılmamıştır. Bu çalışmanın amacı, RM ve PEEP titrasyonunun ARDS’li hastalarda ölü boşluk üzerine etkisini değerlendirmektir.
Gereç ve Yöntem: Bu prospektif gözlemsel çalışmaya erken evre ARDS tanısı almış on iki hasta dahil edilmiştir. Başlangıç stabilizasyonunun ardından, tüm hastalara standart bir RM protokolü uygulanmış ve ardından azalan PEEP titrasyonu gerçekleştirilmiştir. RM ve bireyselleştirilmiş PEEP titrasyonu öncesi ve sonrasında ölü boşluk parametreleri, akciğer mekaniği, kan gazları ve hemodinamik değişkenler ölçülmüştür.
Bulgular: RM sonrasında hem hava yolu ölü boşluğu hem de fizyolojik ölü boşlukta istatistiksel olarak anlamlı bir azalma gözlenmiştir. PaO₂ ve oksijen satürasyonu artarken, arteriyel pH’ta hafif bir düşüş saptanmıştır. Alveoler ölü boşluk, kompliyans, hava yolu basınçları, son-tidal CO₂ ve hemodinamik parametrelerde ise anlamlı bir değişiklik izlenmemiştir.
Sonuç: Erken dönem ARDS’de, RM’ler ve PEEP ile uygulanan bireyselleştirilmiş ventilasyon stratejileri, belirgin bir hemodinamik bozulmaya yol açmadan fizyolojik ölü boşluğu azaltabilir ve oksijenasyonu iyileştirebilir. Bu bulgular, gaz değişimini optimize etmeye yardımcı olmak ve klinik sonuçları potansiyel olarak iyileştirmek amacıyla, kişiselleştirilmiş yaklaşımlara ölü boşluk monitörizasyonunun dahil edilebileceğini düşündürmektedir.

Keywords

Akut solunum sıkıntısı sendromu (ARDS) , Ölü boşluk , Recruitment manevrası , PEEP , Mekanik ventilasyon , Solunum mekaniği , Ventilasyon-Perfüzyon oranı

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