Abstract
Recruitment maneuvers (RM) consist of a ventilatory strategy that increases the transpulmonary pressure transiently to reopen the recruitable lung units in acute respiratory distress syndrome (ARDS). The rationales to use RM in ARDS are that there is a massive loss of aerated lung and that once the end-inspiratory pressure surpasses the regional critical opening pressure of the lung units, those units are likely to reopen. There are different methods to perform RM when using the conventional ICU ventilator. The three RM methods that are mostly used and investigated are sighs, sustained inflation, and extended sigh. There is no standardization of any of the above RM. Meta-analysis recommended not to use RM in routine in stable ARDS patients but to run them in case of life-threatening hypoxemia. There are some concerns regarding the safety of RM in terms of hemodynamics preservation and lung injury as well. The rapid rising in pressure can be a factor that explains the potential harmful effects of the RM. In this review, we describe the balance between the beneficial effects and the harmful consequences of RM. Recent animal studies are discussed.
Highlights
Recruitment maneuvers (RM) consist of a ventilatory strategy that increases the transpulmonary pressure transiently to reopen the recruitable lung units in acute respiratory distress syndrome (ARDS)
By contrast, that all of the lung mass can be reopened in early ARDS if a sufficient amount of PL is generated to go over the critical opening pressure (COP) of the lung units [5,6]
The earliest RM ever used during mechanical ventilation is probably the sigh [9], which consists of increasing tidal volume or level of positive end-expiratory
Summary
Recruitment maneuvers (RM) consist of a ventilatory strategy that increases the transpulmonary pressure transiently to reopen the recruitable lung units in acute respiratory distress syndrome (ARDS). Pelosi et al [10] in ten patients with ARDS applied three consecutive sighs per minute, each of them generating Pplat of 45 cm H2O, and found that oxygenation was better, lung static elastance lower, and functional residual capacity (FRC) greater in the 1hour-sigh period than in the no-sigh period.
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