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Lung recruitment in acute respiratory distress syndrome: what is the best strategy?

Keenan, Joseph C.a; Formenti, Paolob; Marini, John J.c

Current Opinion in Critical Care:
doi: 10.1097/MCC.0000000000000054
RESPIRATORY SYSTEM: Edited by Peolo Pelosi
Abstract

Purpose of review: Supporting patients with acute respiratory distress syndrome (ARDS) using a low tidal volume strategy is a standard practice in the ICU. Recruitment maneuvers can be used to augment other methods, like positive end-expiratory pressure and positioning, to improve aerated lung volume. Clinical practice varies widely, and optimal method and patient selection for recruitment maneuvers have not been determined.

Recent findings: Recent developments include experimental and clinical evidence that a stepwise extended recruitment maneuver may match the improvement in aerated lung volume seen with sustained inflation traditionally used, with less adverse effects. Positioning and other chest wall modifications may be useful adjuncts to recruitment maneuvers. In addition, evidence from clinical studies in the operating room suggests that recruitment maneuvers, as a component of an open lung strategy, may be helpful for mechanically ventilated patients with normal lungs.

Summary: As a component of ventilation strategy for patients with ARDS, the use of recruitment maneuvers, especially a stepwise maneuver, in addition to adequate positive end-expiratory pressure and appropriate positioning, is suggested by currently available data. Until their effect on clinical outcomes is further defined, the use of recruitment maneuvers in ARDS and other settings will continue to be guided by individual clinician experience and patient factors.

Author Information

aPulmonary, Allergy, Critical Care and Sleep Medicine Section, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA

bUnità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo – Polo Universitario, Milan, Italy

cPulmonary and Critical Care, Regions Hospital, Saint Paul, University of Minnesota, Minneapolis, Minnesota, USA

Correspondence to Joseph C. Keenan, Pulmonary, Allergy, Critical Care and Sleep Medicine Section, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA. Tel: +1 612 624 0999; e-mail: keen0061@umn.edu

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins