Abstract
BackgroundClinical benefits of recruitment maneuver in ARDS patients are controversial. A number of previous studies showed possible benefits; a large recent study reported that recruitment maneuver and PEEP titration may even be harmful. This meta-analysis was designed to compare the clinical utility of recruitment maneuver with low tidal volume ventilation in adult patients with ARDS.MethodsRandomized controlled trials comparing recruitment maneuver and lung protective ventilation strategy with lung protective strategy ventilation protocol alone in adult patients with ARDS has been included in this meta-analysis. PubMed and Cochrane Central Register of Controlled Trials were searched from inception to 10 November 2017 to identify potentially eligible trials. Pooled risk ratio (RR) and standardized mean difference (SMD) were calculated for binary and continuous variables respectively.ResultsData of 2480 patients from 7 randomized controlled trials have been included in this meta-analysis and systemic review. Reported mortality at the longest available follow-up [RR (95% CI) 0.93 (0.80, 1.08); p = 0.33], ICU mortality [RR (95% CI) 0.91 (0.76, 1.10); p = 0.33] and in-hospital mortality [RR (95% CI) 0.95 (0.83, 1.08); p = 0.45] were similar between recruitment maneuver group and standard lung protective ventilation group. Duration of hospital stay [SMD (95% CI) 0.00 (− 0.09, 0.10); p = 0.92] and duration of ICU stays [SMD (95% CI) 0.05 (− 0.09, 0.19); p = 0.49] were also similar between recruitment maneuver group and standard lung protective ventilation group. Risk of barotrauma was also similar.ConclusionUse of recruitment maneuver along with co-interventions such as PEEP titration does not provide any benefit in terms of mortality, length of ICU, and hospital stay in ARDS patients.
Highlights
IntroductionA number of previous studies showed possible benefits; a large recent study reported that recruitment maneuver and Positive end-expiratory pressure (PEEP) titration may even be harmful
Clinical benefits of recruitment maneuver in Acute respiratory distress syndrome (ARDS) patients are controversial
Complications Only four trials reported incidence of barotrauma from recruitment maneuver, and it was found to be similar with standard lung protective ventilation group [risk ratio (RR) 1.27 (0.68, 2.36); p = 0.45, I2 = 57%, n = 2350]. Principal findings of this meta-analysis and systematic review are that recruitment maneuver neither provides any mortality benefit nor reduces length of hospital and intensive care unit (ICU) stays in adult patients with ARDS
Summary
A number of previous studies showed possible benefits; a large recent study reported that recruitment maneuver and PEEP titration may even be harmful. This meta-analysis was designed to compare the clinical utility of recruitment maneuver with low tidal volume ventilation in adult patients with ARDS. Recruitment maneuver includes elevations of applied airway pressure for short duration aiming to recruit the collapsed alveoli and increase the number of alveolar units participating in tidal ventilation [7]. Positive end-expiratory pressure (PEEP) helps to keep the recruited lung unit ‘open’ and thereby reduces atelectasis and improves oxygenation [8]. Recruitment maneuver provides short-term improvement in oxygenation and lung compliances; on the contrary, it may be associated with barotrauma from increased airway pressure and hemodynamic compromise [6]
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