Recruitment manoeuvres compared to standard care for treatment of acute lung injury or acute respiratory distress syndrome.

A ventilated patient with acute lung injury or acute respiratory distress syndrome may be given a recruitment manoeuvre to open lung units that are collapsed. This is done by using a pressure that is higher than a normal breath for a longer period of time than is required for a normal breath. The effects of recruitment manoeuvres have not, however, been well established. We included seven trials in this review, totalling 1170 participants with acute lung injury or acute respiratory distress syndrome. We found that there was no significant difference in survival between groups given an 'open-lung' ventilatory strategy that included recruitment manoeuvres and groups given standard ventilatory care. Recruitment manoeuvres briefly increased arterial oxygen partial pressure compared to standard care. Recruitment manoeuvres did not affect blood pressure, heart rate, or risk of air leak from the lungs. The main limitation of the review was the design of included trials that either did not isolate recruitment manoeuvres from other variables or assessed only short-term outcomes.