Should Recruitment Maneuvers Be Used in the Management of ALI and ARDS?

Authors: Kacmarek, Robert M1; Kallet, Richard H2

Source: Respiratory Care, Volume 52, Number 5, May 2007 , pp. 622-635(14)

Publisher: The Journal Respiratory Care Company

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Abstract:

Lung recruitment maneuvers are being used in the management of acute lung injury and acute respiratory distress syndrome, but recruitment maneuvers are controversial. The proponents argue that when properly applied to appropriately selected patients, they are effective and can be safely applied. The expectation is that the recruitment maneuver will change the course of ARDS and improve outcomes. Those opposed to recruitment maneuvers argue that no data indicate better outcomes with recruitment maneuvers and that they are potentially unsafe. Outcome data are clearly needed before recruitment maneuvers can be fully incorporated into clinical practice. If a recruitment maneuver is conducted, a decremental positive end-expiratory pressure (PEEP) trial must be done to determine the minimum PEEP that sustains the benefits of the recruitment maneuver. We explore both sides of the lung recruitment controversy.

Keywords: ACUTE LUNG INJURY; ACUTE RESPIRATORY DISTRESS SYNDROME; ALI; ARDS; FRACTION OF INSPIRED OXYGEN; LUNG RECRUITMENT; POSITIVE END-EXPIRATORY PRESSURE

Document Type: Research Article

Affiliations: 1: Respiratory Care Services, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 2: Cardiovascular Research Institute, and with Respiratory Care Services, Department of Anesthesia, University of California, San Francisco, at San Francisco General Hospital, San Francisco, California

Publication date: May 1, 2007

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