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

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 PaO(2)/FiO(2) 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 H(2)O at baseline to 29.51 ± 14.58 mL/cm H(2)O. In the VCV group the lung compliance improved from 24.78 ± 4.87 mL/cm H(2)O to 31.31 ± 10.88 mL/cm H(2)O. 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.