Lung Recruitment Maneuvers for ARDS Patients: A Systematic Review and Meta-Analysis

Abstract

Background: Lung recruitment maneuvers (LRMs) may reduce mortality and improve oxygenation in patients with acute respiratory distress syndrome (ARDS). However, the existing literature provides controversial conclusions. Objectives: To determine whether LRMs have benefits on ARDS patients. Searching Methods: We searched relevant studies in PubMed, EMBASE, Medline, and the Cochrane Library up to May 2018. We considered for inclusion all prospective and randomized controlled trials which compared LRMs and non-LRM in adult patients with ARDS. We collected data about in-hospital mortality, 28-day mortality, the length of ICU and hospital stay, PaO₂/FiO₂, and FiO₂. Main Results: Ten trials including 3,025 patients were analyzed. No significant difference was found in the hospital and 28-day mortality, as well as the length of ICU stay and oxygen requirement, even undergoing subgroup analysis. However, the results of this meta-analysis showed a significant benefit of LRMs for shortening the length of hospital stay (mean difference, MD = –1.75; 95% CI, –3.40 to –0.09; p = 0.04; p for heterogeneity = 0.3, I² = 18%) and improving PaO₂/FiO₂ ratio on the third day (MD = 52.72; 95% CI, 18.77–86.67; p = 0.002), but with extremely high heterogeneity (p for heterogeneity <0.0001, I² = 99%). Conclusion: LRMs do not produce significant reduction of mortality in patients with ARDS but may shorten the length of hospital stay and improve oxygenation on the third day. However, the results must be interpreted cautiously as most studies were on multiple intervention exposures.