Hindawi Publishing Corporation Critical Care Research and Practice Volume 2012, Article ID 428798, 6 pages doi:10.1155/2012/428798 Clinical Study Derecruitment Test and Surfactant Therapy in Patients with Acute Lung Injury Alexey A. Smetkin, 1, 2, 3 Vsevolod V. Kuzkov, 1, 2 Konstantin M. Gaidukov, 1, 2 Lars J. Bjertnaes, 3 and Mikhail Y. Kirov 1, 2, 3 1 Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Avenue 51, Arkhangelsk 163000, Russia 2 Department of Anesthesiology and Intensive Care Medicine, City Hospital No. 1 of Arkhangelsk, Suvorov Street 1, Arkhangelsk 163001, Russia 3 Department of Clinical Medicine (Anesthesiology), Faculty of Medicine, University of Tromsoe, MH-Breivika, 9038 Tromsoe, Norway Correspondence should be addressed to Mikhail Y. Kirov, mikhail kirov@hotmail.com Received 10 May 2012; Accepted 5 July 2012 Academic Editor: Zsolt Molnar Copyright © 2012 Alexey A. Smetkin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. A recruitment maneuver (RM) may improve gas exchange in acute lung injury (ALI). The aim of our study was to assess the predictive value of a derecruitment test in relation to RM and to evaluate the efficacy of RM combined with surfactant instillation in patients with ALI. Materials and Methods. Thirteen adult mechanically ventilated patients with ALI were enrolled into a prospective pilot study. The patients received protective ventilation and underwent RM followed by a derecruitment test. After a repeat RM, bovine surfactant (surfactant group, n = 6) or vehicle only (conventional therapy group, n = 7) was instilled endobronchially. We registered respiratory and hemodynamic parameters, including extravascular lung water index (EVLWI). Results. The derecruitment test decreased the oxygenation in 62% of the patients. We found no significant correlation between the responses to the RM and to the derecruitment tests. The baseline EVLWI correlated with changes in SpO 2 following the derecruitment test. The surfactant did not affect gas exchange and lung mechanics but increased EVLWI at 24 and 32 hrs. Conclusions. Our study demonstrated no predictive value of the derecruitment test regarding the effects of RM. Surfactant instillation was not superior to conventional therapy and might even promote pulmonary edema in ALI. 1. Introduction Acute lung injury (ALI) is associated with significant mor- bidity and mortality in critically ill patients [1–3]. Several mechanisms are involved in the development of ALI. The enhanced pulmonary capillary leakage causing pulmonary edema is one of the key factors. Another important mecha- nism is the formation of atelectases secondary to depletion of surfactant and accumulation of lung tissue fluid [4–6]. The latter mechanisms in combination with derangement of hypoxic pulmonary vasoconstriction may cause increased venous admixture and progressive deterioration of oxygena- tion [4, 7, 8]. The recruitment maneuver (RM) is a widely used tech- nique aiming to reopen atelectatic lung areas in patients with ALI. Transient increase in the airway pressure up to 40–60 cm H 2 O for 40–60 sec reexpands the deaerated lung tissue areas and improves oxygenation [9–11]. However, the influence of RM on the outcome is controversial [12, 13]. Moreover, RM has a number of adverse effects; the most significant of those are barotrauma and cardiovascular collapse [14– 17]. The risks of RM are justified predominantly in potential responders, necessitating a search for tests that can predict the response to the maneuver. The airway suctioning procedures require deliberate disconnection of airway tubes thereby reducing PEEP to 0 cm H 2 O. This may lead to alveolar derecruitment that produces effects opposite to those of the RM [18]. The most prominent of these effects are reduction of lung compliance and significant decrease in arterial oxygenation. We hypothesized