title: Recruitment maneuvers for acute lung injury: a systematic review.
abstract: BACKGROUND
  There are conflicting data regarding the safety and efficacy of recruitment maneuvers (RMs) in patients with acute lung injury (ALI).
  
  
  OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Wilcox
authors.forename: Roy G
authors.initials: RG
authors.lastname: Brower
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Stewart
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Lapinsky
authors.forename: Maureen O
authors.initials: MO
authors.lastname: Meade
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
mesh_terms: D055371:Acute Lung Injury / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012121:Respiration, Artificial / Q000009:adverse effects*; D012129:Respiratory Function Tests
chemical_list: D010100:Oxygen