Lung recruitment: the role of recruitment maneuvers.
There is increasing appreciation that lung-protective strategies are beneficial in patients with acute respiratory distress syndrome. Using low tidal volume in these patients improves survival. However, low tidal volume ventilation may promote alveolar de-recruitment. This has led some to advocate the use of "open lung" strategies that stress the use of high positive end-expiratory pressure levels and recruitment maneuvers. A recruitment maneuver is a sustained increase in airway pressure with the goal to open collapsed lung tissue. A variety of approaches have been used as recruitment maneuvers, including increasing the level of positive end-expiratory pressure, sustained inflation maneuvers, sigh breaths, spontaneous breathing, and others. There have been a number of recent reports describing improvements in arterial oxygenation with the use of recruitment maneuvers. However, the impact of recruitment maneuvers on patient-important outcomes such as survival is unknown.
Hess
Dean R
DR
Department of Respiratory Care Services, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 02114, USA. dhess@partners.org
Bigatello
Luca M
LM
D000768:Anesthesia, General; D000818:Animals; D006612:High-Frequency Ventilation; D006801:Humans; D011175:Positive-Pressure Respiration; D011650:Pulmonary Alveoli / Q000503:physiopathology; D001261:Pulmonary Atelectasis / Q000503:physiopathology; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy; D012131:Respiratory Insufficiency / Q000503:physiopathology* / Q000628:therapy*; D013990:Tidal Volume