Recruitment Maneuvers for ARDS

• Patients with ARDS who are ventilated with lung protective settings are at risk of derecruitment/collapse of lung units.
• Recruitment maneuvers are processes that transiently increase transpulmonary pressure to open collapsed units.
• These maneuvers can improve oxygenation and have been used in patients with ARDS and those with refractory hypoxemia.
• The various types of recruitment methods include:
  • Airway pressure-based maneuver: a continuous positive airway pressure of 35-45 cm H₂O is applied for 30-40 seconds
  • Ventilator modes: Airway pressure release ventilation (APRV) and high-frequency oscillatory ventilation (HFOV)
  • Prone positioning
• Adverse events can occur with recruitment maneuvers and include hypotension, hypoxia, and pneumothorax (rare).

References

Keenan JC, et al. Lung recruitment in acute respiratory distress syndrome: what is the best strategy? Curr Opin Crit Care 2014; 20:63-8.