Year in Review 2015: Recruitment manoeuvres in ARDS

Abstract

Refractory hypoxaemia is a problem in patients with acute respiratory distress syndrome (ARDS). Although mechanical ventilation is the mainstay of management of ARDS, this therapy itself can cause damage to the lungs due to high tidal volume and high airway pressures. Lung protective strategies are used to reduce damage to the lungs due to mechanical ventilation. Use of small tidal volumes can cause alveolar derecruitment and arterial hypoxaemia. Lung recruitment manoeuvre (RM) opens up collapsed segments of the ARDS lung but the collapse may reappear once the RM is complete. Although RM has been shown to improve oxygenation there is still no clear data showing improvement in clinical outcome. This review summarises the different techniques used for RM, physiological effects of RM on lung mechanics along with monitoring RM at the bedside.