At present, there is a lack of practical and effective methods to evaluate lung recruitment maneuver in patients with acute respiratory distress syndrome (ARDS) in the clinic.

To evaluate the potential of inflammatory factors (IF) from bronchoalveolar lavage fluid (BALF) for lung recruitment maneuver (RM) in patients with ARDS.

Sixty-two ARDS patients requiring invasive mechanical ventilation in ICU at Affiliated Jinhua hospital of Zhejiang University School of Medicine from March 2020 to March 2022 were included for the study. The levels of IL-6, IL-8, IL-10 in BALF, lung ultrasound score (LUS) and oxygenation index (PaO₂/FiO₂) , which were monitored before and on the 3rd day after the RM. According to the differences in LUS (ΔLUS) before and after RM, patients were divided into RM effective group (RM-E group) with the value greater than 5 points and RM inactive group (RM-N group) with the value less than 5 points, and the changes of IF in BALF were compared between the two groups; the correlations between ΔIF, differences of IF between the two groups before and after RM, and ΔLUS (ΔIL-6, ΔIL-8, ΔIL-10 and ΔLUS) were analyzed. The ROC was used to calculate the predictive value of IF in BALF for the potential of RM.

The study enrolled 38 patients in the RM-E group and 24 in the RM-N group. There was no statistical difference in the levels of IL-6, IL-8 and IL-10 in BALF and LUS between the two groups before RM (P>0.05) . There was also no significant difference in tidal volume (VT) , positive end expiratory pressure (PEEP) , plateau pressure (P_plat) , fraction of inspiration O₂ (FiO₂) and PaO₂/FiO₂ between the two groups (P>0.05) . The levels of IL-6, IL-8, IL-10 in BALF and PaO₂/FiO₂ before and after RM in the two groups were statistically significant (P<0.05) . There was significant difference in LUS before and after RM in RM-E group (P<0.05) , but no significant difference in LUS before and after RM in RM-N group (P>0.05) . After RM, the difference of ΔIL-6, ΔIL-8, ΔIL-10 and ΔLUS was statistically significant in the two groups (P<0.05) . Correlation analysis showed that ΔIL-6 and ΔLUS had a significant positive correlation (P<0.05) , while ΔIL-8, ΔIL-10 and ΔLUS had no significant correlation (P>0.05) . The area under the curve (AUC) predicted RM potential by ΔIL-6 in patients with ARDS was 0.794, the sensitivity was 94.7%, and the specificity was 70.8%.

The detection of IF in BALF, especially IL-6, has a certain clinical value in evaluating the lung recruitment maneuver potential in patients with ARDS.

目前临床上缺少实用有效的对急性呼吸窘迫综合征（ARDS）患者肺可复张性评估方法。

探究肺泡灌洗液（BALF）中炎性因子对ARDS患者肺复张（RM）潜能的预测价值。

选取2020年3月至2022年3月浙江大学医学院附属金华医院ICU收治的需有创机械通气的ARDS患者62例为研究对象，所有患者在RM前及RM后第3天进行纤维支气管镜下肺泡灌洗，检测BALF中白介素（IL）-6、IL-8、IL-10水平，肺部超声评分（LUS）及氧合指数（PaO₂/FiO₂）。根据RM前后LUS差值（ΔLUS）是否大于5分分为RM有效组（RM-E组）及RM无效组（RM-N组），比较两组患者BALF中炎性因子变化；分析两组RM前后炎性因子差值（ΔIL-6、ΔIL-8、ΔIL-10）和ΔLUS的相关性。采用受试者工作特征（ROC）曲线分析BALF炎性因子差值对RM潜能的预测价值。

RM-E组患者38例，RM-N组患者24例，RM前两组患者的LUS及BALF中IL-6、IL-8、IL-10水平比较，差异均无统计学意义（P>0.05）；两组患者的潮气量（VT）、呼气末正压（PEEP）、平台压（P_plat）、吸入氧浓度（FiO₂）及PaO₂/FiO₂比较，差异均无统计学意义（P>0.05）。两组患者BALF中IL-6、IL-8、IL-10水平及PaO₂/FiO₂ RM前后自身比较，差异均有统计学意义（P<0.05）；RM-E组RM前后LUS比较，差异有统计学意义（P<0.05）；而RM-N组RM前后LUS比较，差异无统计学意义（P>0.05）。RM后两组患者的ΔIL-6、ΔIL-8、ΔIL-10及ΔLUS比较，差异均有统计学意义（P<0.05）。相关性分析提示ΔIL-6与ΔLUS呈正相关（P<0.05），ΔIL-8、ΔIL-10与ΔLUS无直线相关关系（P>0.05）。ΔIL-6预测RM潜能的ROC曲线下面积（AUC）为0.794，灵敏度为94.7%，特异度为70.8%。

检测BALF中炎性因子，尤其是IL-6对评估ARDS患者RM潜能有一定的临床价值。