Key result
An alveolar recruitment maneuver of 30 cmH2O for 30 seconds significantly reduced regional cerebral oxygen saturation by 6% and middle cerebral artery blood velocity by 26% compared to a sham maneuver.
Why the study?
This study aimed to determine the effects of an alveolar recruitment maneuver on cerebral oxygen saturation and cerebral blood velocity in patients undergoing carotid endarterectomy before carotid artery clamping.
Does an alveolar recruitment maneuver reduce cerebral oxygen saturation and cerebral blood flow velocity in patients undergoing carotid endarterectomy?
RCT (n=59)
Randomized crossover
No
Does an alveolar recruitment maneuver reduce cerebral oxygen saturation and cerebral blood flow velocity in patients undergoing carotid endarterectomy?
Absolute Event Rate: -6% vs 1%
p-value: p=<0.001
In patients undergoing carotid endarterectomy, an alveolar recruitment maneuver significantly decreases regional cerebral oxygen saturation and middle cerebral artery blood velocity.
RM may transiently reduce cerebral oxygenation and flow before carotid clamping; leaves open clinical relevance in CEA.
BACKGROUND This study aimed to determine the effects of alveolar recruitment maneuver (RM) on cerebral oxygen saturation and cerebral blood velocity in patients undergoing carotid endarterectomy (CEA) before clamping of the carotid artery. MATERIAL AND METHODS In this crossover exploratory study, all patients were randomized to undergo an RM (30 cmH₂O of continuous airway pressure for 30 s) and a "sham" maneuver (SM; 5 cmH₂O for 30 s), followed by an alternative intervention after a 5-min equilibration period. Near-infrared spectroscopy (NIRS) was used to monitor regional cerebral oxygen saturation (rSO₂), and transcranial Doppler ultrasonography (TCD) to evaluate blood velocity of the middle cerebral artery (V-MCA). Changes in rSO₂, V-MCA, mean arterial pressure (MAP), and heart rate (HR) in response to the 2 interventions were compared. RESULTS A total of 59 patients underwent the study procedure. RM reduced rSO₂, V-MCA, MAP, and HR, but these variables slightly changed during SM. A significant drop in rSO₂ was observed immediately after RM compared with the baseline value (68.51±4.4% vs 64.12±5.15%; P<0.001). The decrease in rSO₂ was higher during the RM than during the SM (-6±4% vs 1±2%; P<0.001). Similarly, change in V-MCA was more significant in response to RM than SM (-26±19% vs 19±16%; P<0.001). The V-MCA value changed from 39 cm/s to 29 cm/s after RM. In addition, V-MCA of the ipsilateral to the surgical side decreased more obviously than the contralateral side (-26±19% vs -20±17%; P=0.001). CONCLUSIONS An RM at 30 cmH₂O of continuous airway pressure for 30 s decreased rSO₂ and V-MCA. In addition, MAP and HR were affected.
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Li et al. (2021) conducted an RCT in Carotid artery stenosis (n=59). Alveolar recruitment maneuver vs. Sham maneuver (5 cmH2O for 30 s) was evaluated on Relative change in regional cerebral oxygen saturation (rSO2) (p=<0.001). An alveolar recruitment maneuver of 30 cmH2O for 30 seconds significantly reduced regional cerebral oxygen saturation by 6% and middle cerebral artery blood velocity by 26% compared to a sham maneuver.
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