Recruitment Maneuvers for Acute Lung Injury
Abstract
Rationale: There are conflicting data regarding the safety and efficacy of recruitment maneuvers (RMs) in patients with acute lung injury (ALI). Objectives: To summarize the physiologic effects and adverse events in adult patients with ALI receiving RMs. Methods>: Systematic review of case series, observational studies, and randomized clinical trials with pooling of study-level data. Measurements and Main Results: Forty studies (1,185 patients) met inclusion criteria. Oxygenation (31 studies; 636 patients) was significantly increased after an RM (PaO2: 106 versus 193 mm Hg, P = 0.001; and PaO2/FiO2 ratio: 139 versus 251 mm Hg, P < 0.001). There were no persistent, clinically significant changes in hemodynamic parameters after an RM. Ventilatory parameters (32 studies; 548 patients) were not significantly altered by an RM, except for higher PEEP post-RM (11 versus 16 cm H2O; P = 0.02). Hypotension (12%) and desaturation (9%) were the most common adverse events (31 studies; 985 patients). Serious adverse events (e.g., barotrauma [1%] and arrhythmias [1%]) were infrequent. Only 10 (1%) patients had their RMs terminated prematurely due to adverse events. Conclusions: Adult patients with ALI receiving RMs experienced a significant increase in oxygenation, with few serious adverse events. Transient hypotension and desaturation during RMs is common but is self-limited without serious short-term sequelae. Given the uncertain benefit of transient oxygenation improvements in patients with ALI and the lack of information on their influence on clinical outcomes, the routine use of RMs cannot be recommended or discouraged at this time. RMs should be considered for use on an individualized basis in patients with ALI who have life-threatening hypoxemia.
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Selected patients with severe hypoxemia may benefit from recruitment maneuvers in conjunction with higher levels of PEEP, but little evidence supports the routine use in all ARDS patients, so recommendations are focused to patients with moderate-to-severe ARDS.
“Selected patients with severe hypoxemia may benefit from recruitment maneuvers in conjunction with higher levels of PEEP, but little evidence supports the routine use in all ARDS patients, so we have focused our recommendations to patients with moderate-to-severe ARDS [453].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [453]
Although the effects of recruitment maneuvers improve oxygenation initially, the effects can be transient.
“Although the effects of recruitment maneuvers improve oxygenation initially, the effects can be transient [453].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [453]
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- Authors
- Fan, E., Wilcox, M. E., Brower, R. G., Stewart, T. E., Mehta, S., Lapinsky, S. E., Meade, M. O., & Ferguson, N. D.
- Affiliations
- Johns Hopkins University (US)
- University of Toronto (CA)
- McMaster University (CA)
- University Health Network (CA)
- ORCID
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-12-01
- Volume
- 178
- Issue
- 11
- Pages
- 1156-1163
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W1940579175
- Cited by
- 328
- References
- 62
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 9 · 2023: 13 · 2022: 17 · 2021: 15 · 2020: 12 · 2019: 8 · 2018: 12 · 2017: 28 · 2016: 21 · 2015: 29 · 2014: 18 · 2013: 30 · 2012: 28
- FWCI
- 24.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- recruitment maneuvers, acute lung injury, positive end-expiratory pressure, oxygenation, PaO2/FiO2 ratio, hypotension, desaturation, barotrauma, cardiac arrhythmias, mechanical ventilation, hypoxemia
- MeSH terms
- Adult, Female, Hemodynamics, Humans, Male, Middle Aged, Oxygen, Respiration, Artificial, Respiratory Function Tests, Acute Lung Injury
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