title: Clinical review: the implications of experimental and clinical studies of recruitment maneuvers in acute lung injury.
abstract: Mechanical ventilation can cause and perpetuate lung injury if alveolar overdistension, cyclic collapse, and reopening of alveolar units occur. The use of low tidal volume and limited airway pressure has improved survival in patients with acute lung injury or acute respiratory distress syndrome. The use of recruitment maneuvers has been proposed as an adjunct to mechanical ventilation to re-expand collapsed lung tissue. Many investigators have studied the benefits of recruitment maneuvers in healthy anesthetized patients and in patients ventilated with low positive end-expiratory pressure. However, it is unclear whether recruitment maneuvers are useful when patients with acute lung injury or acute respiratory distress syndrome are ventilated with high positive end-expiratory pressure, and in the presence of lung fibrosis or a stiff chest wall. Moreover, it is unclear whether the use of high airway pressures during recruitment maneuvers can cause bacterial translocation. This article reviews the intrinsic mechanisms of mechanical stress, the controversy regarding clinical use of recruitment maneuvers, and the interactions between lung infection and application of high intrathoracic pressures.
authors.affiliation: Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Piacentini
authors.forename: Ana
authors.initials: A
authors.lastname: Villagrá
authors.forename: Josefina
authors.initials: J
authors.lastname: López-Aguilar
authors.forename: Lluis
authors.initials: L
authors.lastname: Blanch
mesh_terms: D000208:Acute Disease; D035843:Biomedical Research; D003422:Critical Care / Q000379:methods*; D006801:Humans; D011014:Pneumonia; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D001261:Pulmonary Atelectasis; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*