Patients who are intubated and mechanically ventilated in the intensive care unit (ICU) require repeated endotracheal suctioning to remove airway secretions. Although this procedure is necessary, it can cause a temporary collapse of lung units (alveolar derecruitment), leading to a decrease in lung volume and impaired oxygenation.
A recruitment maneuver consists of briefly applying a higher airway pressure after suctioning in order to reopen collapsed lung areas and restore lung volume. However, the clinical benefit of performing a recruitment maneuver systematically after suctioning remains uncertain.
This study aims to evaluate whether performing a recruitment maneuver immediately after closed-circuit endotracheal suctioning improves lung volume compared with suctioning alone. Lung volume will be assessed using electrical impedance tomography (EIT), a non-invasive bedside imaging technique that allows real-time monitoring of lung aeration.
In a randomized crossover design, each patient will undergo two suctioning procedures: one followed by a recruitment maneuver and one without, in a random order. The main outcome will be the change in end-expiratory lung volume 15 minutes after suctioning. The results may help optimize ventilatory care in mechanically ventilated ICU patients.
Adults aged ≥18 years
Covered by national health insurance
Admitted to the intensive care unit
Intubated and mechanically ventilated
Contraindication to electrical impedance tomography (e.g. pacemaker, implantable cardioverter-defibrillator, or implanted electrical stimulation device)
Contraindication to recruitment maneuvers (e.g. emphysema, undrained pneumothorax, hemodynamic instability)
Refractory intracranial hypertension
Acute respiratory distress syndrome requiring prone positioning
Crossover
Suction + Recruitment maneuver
Procedure/SurgeryAfter suctioning, a recruitment maneuver is applied consisting of an airway pressure of 30 cmH₂O maintained for 30 seconds, without changing the positive end-expiratory pressure.
Closed-circuit endotracheal suctioning
Procedure/SurgeryStandard closed-circuit endotracheal suctioning performed for less than 15 seconds without disconnecting the ventilator.
Percentage change in end-expiratory lung volume (EELV) after suctioning
EELV assessed by end-expiratory lung impedance measured with electrical impedance tomography (PulmoVista® V500).
Change in lung compliance
Measured from ventilator-derived respiratory mechanics.
Change in functional residual capacity (FRC)
Measured by nitrogen washout using the CARESCAPE R860 ventilator.
Change in PaO₂/FiO₂ ratio
Calculated from arterial blood gas analysis.
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