Recruitment maneuvers for acute respiratory distress syndrome: the panorama in 2016 - Critical Care Science (CCS)

CONCLUSION

Even though experimental studies, systematic reviews, and meta-analyses have suggested that RMs are associated with beneficial effects for lung function and morphology in ARDS, their impact on clinical outcomes is still being debated. Different methods with different benefit and risk profiles have been used to recruit the lungs, and further studies are required to identify the optimal RM method. Lung mechanical parameters associated with ventilator-induced lung injury, such as driving pressure, energy, and mechanical power, have been evaluated recently and should be used to assess the beneficial effects of lung recruitment and the outcomes of ARDS patients. The etiology, severity, and timing of ARDS need to be considered before choosing to recruit the lungs. In this context, the realization that a specific lung area can be opened may reduce the indiscriminate use of RMs for ARDS, as not all lungs are recruitable and, depending on the RM technique used, further lung damage may occur. Additionally, some ventilatory approaches (e.g., variable ventilation and airway pressure release ventilation) can safely recruit ARDS-affected lungs in ways that may minimize pulmonary damage and improve outcomes.

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