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Critical Care  2012 

Recruitment maneuver after apnea test or continuous positive airway pressure apnea test?

DOI: 10.1186/cc11453

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Armelle Nicolas-Robin and Marie PariesWe thank Dr Lacroix and colleagues for their interest in our study and we appreciate the opportunity to respond. We wish to remind that the aim of our study [1] was not to compare the PaO2/FiO2 ratio after apnea tests performed by disconnecting or not the patient from the ventilator. It was to show that hypoxemia after disconnection from the ventilator may be prevented by a single RM applied just after reconnection. Dr Lacroix theorizes that a RM is not useful if the apnea test is performed without disconnection in the CPAP mode. This hypothesis has not been validated, even by Mascia and colleagues [2], who showed that a global lung protective strategy (including no disconnection plus RMs) improved the PaO2/FiO2 ratio, compared with the conventional strategy (including disconnection with no RM). To our knowledge, the only prevention by the non-disconnection in the CPAP mode has not been evaluated. Our study demonstrated the interest of RM in the case of an apnea test performed by disconnecting the patient from the ventilator. This result is all the more useful because an apnea test performed without disconnection in the CPAP mode is not possible with all ventilators, especially those that do not allow inhibition of the apnea ventilation security mode in case of prolonged apnea.CPAP: continuous positive airway pressure; FiO2: fractional inspired oxygen; PaO2: arterial oxygen tension; RM: recruitment maneuver.The authors declare that they have no competing interests.


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