Guerin et al. Annals of Intensive Care 2011, 1:9 REVIEW Open Access Efficacy and safety of recruitment maneuvers in acute respiratory distress syndrome Claude Guerin*, Sophie Debord, Véronique Leray, Bertrand Delannoy, Frédérique Bayle, Gael Bourdin and Jean-Christophe Richard Abstract Recruitment maneuvers (RM) consist of a ventilatory strategy that increases the transpulmonary pressure transiently to reopen the recruitable lung units in acute respiratory distress syndrome (ARDS). The rationales to use RM in ARDS are that there is a massive loss of aerated lung and that once the end-inspiratory pressure surpasses the regional critical opening pressure of the lung units, those units are likely to reopen | Guerin et al. Annals of Intensive Care 2011 1 9 http content 1 1 9 Ù Annals of Intensive Care a SpringerOpen Journal REVIEW Open Access Efficacy and safety of recruitment maneuvers in acute respiratory distress syndrome Claude Guerin Sophie Debord Véronique Leray Bertrand Delannoy Frédérique Bayle Gael Bourdin and Jean-Christophe Richard Abstract Recruitment maneuvers RM consist of a ventilatory strategy that increases the transpulmonary pressure transiently to reopen the recruitable lung units in acute respiratory distress syndrome ARDS . The rationales to use RM in ARDS are that there is a massive loss of aerated lung and that once the end-inspiratory pressure surpasses the regional critical opening pressure of the lung units those units are likely to reopen. There are different methods to perform RM when using the conventional ICU ventilator. The three RM methods that are mostly used and investigated are sighs sustained inflation and extended sigh. There is no standardization of any of the above RM. Meta-analysis recommended not to use RM in routine in stable ARDS patients but to run them in case of lifethreatening hypoxemia. There are some concerns regarding the safety of RM in terms of hemodynamics preservation and lung injury as well. The rapid rising in pressure can be a factor that explains the potential harmful effects of the RM. In this review we describe the balance between the beneficial effects and the harmful consequences of RM. Recent animal studies are discussed. Definition Recruitment maneuvers RM can be defined as a voluntary strategy to increase the transpulmonary pressure PL transiently with the goal to reopen those alveolar units that are not aerated or poorly aerated but reopenable. The consequence of this should be the induction of lung recruitment. This strategy can be performed by using the conventional ICU ventilator or the high-frequency oscillation device in the supine or prone positions. This review .
