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Recruitment manoeuvres in acute lung injury/acute respiratory distress syndrome

¹ Intensive Care Service Hospital de la Santa Creu i Sant Pau, and ² Surgical Intensive Care Unit Hospital Clínic, Barcelona, Spain. ³ Critical Care Center Hospital de Sabadell Corporacio Sanitaria Parc Taulí, Sabadell, Spain

CORRESPONDENCE: J. Mancebo, Servei de Medicina Intensiva Hospital de la Santa Creu i Sant Pau, Sant Antoni M Claret, 167, Barcelona 08025, Spain. Fax: 34 932919280. E-mail: jmancebo@hsp.santpau.es

Keywords: acute lung injury, acute respiratory distress syndrome, lung protective strategy, mechanical ventilation, positive end-expiratory pressure

Acute respiratory distress syndrome/acute lung injury is characterised by profound hypoxaemia due to a permeability pulmonary oedema.

In this setting, recruitment manoeuvres (RMs) can be a useful tool as adjuncts to lung protective ventilatory strategies to prevent cyclic alveolar stress and avoid alveolar collapse.

Many experimental and physiological studies have discussed the use of RMs but only a few heterogeneous clinical experiences have demonstrated the beneficial and deleterious effects that can occur using these manoeuvres. Besides, a lot of questions remain to be answered to find the best way to perform optimal RMs.

Further experimental and clinical trials are needed to understand the potential beneficial effects of recruitment manoeuvres when using a protective mechanical ventilation strategy. This paper is a general review of experimental works that support application of recruitment manoeuvres emphasising the clinical studies that have been published to date in acute respiratory distress syndrome patients.