title: Complications from recruitment maneuvers in patients with acute lung injury: secondary analysis from the lung open ventilation study.
abstract: BACKGROUND
  There are limited data on the safety and efficacy of recruitment maneuvers (RMs) in acute lung injury (ALI) patients.
  
  
  OBJECTIVE
  To evaluate the frequency, timing, and risk factors for complications from RMs in adult ALI patients.
  
  
  METHODS
  Secondary analysis of data from  a randomized controlled trial of a lung open ventilation strategy that included sustained inflation RMs.
  
  
  RESULTS
  Respiratory (eg, desaturation) and cardiovascular (eg, hypotension) complications from recruitment maneuvers were common (22% of all patients receiving RMs), and the majority occurred  within 7 days of enrollment. New air leak through an existing chest tube was uncommon (< 5%). As compared to patients receiving 1 or fewer RMs, the number of RMs received was associated with increased risk in both younger (age ≤ 56 y) and older patients (age > 56 y): 2 RMs odds ratio  [OR] 6.92 (95% CI 1.70-28.2), ≥ 3 RMs OR 15.4 (95% CI 4.77-49.6), and 2 RMs OR 5.43 (95% CI 1.76-16.8), ≥ 3 RMs OR 4.93 (95% CI 1.78-13.7), respectively. Patients with extrapulmonary ALI had decreased odds of developing complications (OR 0.42, 95% CI 0.22-0.80).
  
  
  CONCLUSIONS
  Complications in adult ALI patients receiving RMs were common, but serious complications (eg, new air leak through an existing chest tube) were infrequent. There is a significant association between the number of RMs received and complications, even after controlling for illness  severity and duration. Given their uncertain benefit in ALI patients, and the potential for complications with repeated application, the routine use of sustained inflation RMs is not justified.
authors.affiliation: Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. efan@mtsinai.on.ca
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.forename: William
authors.initials: W
authors.lastname: Checkley
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Stewart
authors.forename: John
authors.initials: J
authors.lastname: Muscedere
authors.forename: Olivier
authors.initials: O
authors.lastname: Lesur
authors.forename: John T
authors.initials: JT
authors.lastname: Granton
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Freitag
authors.forename: Michael
authors.initials: M
authors.lastname: Jacka
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.forename: Maureen O
authors.initials: MO
authors.lastname: Meade
mesh_terms: D055371:Acute Lung Injury / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000009:adverse effects*; D012129:Respiratory Function Tests; D012138:Respiratory Therapy / Q000009:adverse effects*; D012307:Risk Factors